Module 4 Canvas Practice Questions Flashcards

1
Q

A separate placental lobe attached by blood vessels to the main placenta is called a

A) Circumvallate
B) Battledore
C) Succenturiate
D) Partial

A

C) Succenturiate

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2
Q

Movement of substances from an area of higher to lower concentration is the definition of which of the following?

A) simple (passive) diffusion
B) facilitated diffusion
C) Pinocytosis
D) Endocytosis

A

A) simple (passive) diffusion

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3
Q

Immunologic functions of the placenta include protection of the fetus from pathogens and

A) Passage of IgM
B) Prevention from rejection by the mother
C) Active immunity to many diseases
D) Encouraging fetal growth

A

B) Prevention from rejection by the mother

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4
Q

The earliest system to differentiate in the embryo is the

A) Nervous system
B) Respiratory system
C) Gastrointestinal system
D) Renin/angiotensin system

A

A) Nervous system

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5
Q

Which of the following is the major source of amniotic fluid?

A) Fetal urine output
B) Fetal lung fluid
C) Fetal swallowing
D) Intramembranous movement

A

A) Fetal urine output

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6
Q

The most likely etiology for symptoms of dizziness, nausea, and diaphoresis when a pregnant woman is lying in a supine position is:

A) orthostatic hypotension
B) hypoglycemia
C) vena cava compression
D) situational anxiety

A

C) vena cava compression

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7
Q

Which of the following hormones of pregnancy stimulates the corpus luteum to continue to function?

A) Estrogen
B) Luteinizing hormone
C) Human chorionic gonadotropin
D) Human placental lactogen

A

C) Human chorionic gonadotropin

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8
Q

T/F: Epigenetic changes may be passed to offspring because these changes are maintained through mitosis and are passed on during meiosis.

A

True

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9
Q

What structure is located on the fetal side of the placenta and is continuous with the membranes?

A) chorionic plate
B) decidua capsuleris
C) placenta circumvillata
D) fetal blood vessels

A

A) chorionic plate

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10
Q

A father is heterozygous for brown eyes. A mother is homozygous recessive for blue eyes. All of their children will have a _____% chance of having brown eyes.

A

50%

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11
Q

Upon reviewing a woman’s routine 28 week lab results, the CNM/WHNP notes that her hemoglobin and hematocrit are lower than in the nonpregnant woman, yet not low enough to diagnose her as being anemic. The CNM/WHNP knows that this is most likely due to physiologic anemia of pregnancy, which is caused by:

A) Increased plasma volume that outpaces the increase in RBC production
B) Decreased RBC production in pregnancy
C) Decreased total blood volume that normally occurs during pregnancy
D) Venous distensibility contributing to increased edema affecting the amount of circulating blood volume

A

A) Increased plasma volume that outpaces the increase in RBC production

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12
Q

At approximately 4-5 days after fertilization, the morula reaches the uterine cavity and becomes the:

A) blastocyst
B) blastomere
C) zygote
D) pronucleus

A

A) blastocyst

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13
Q

What causes physiologic anemia of pregnancy?

A) the cellular portion increases more than the plasma portion.
B) the plasma portion increases more than the cellular portion.
C) red blood cells are equal to the plasma portion.
D) white blood cells are equal to the plasma portion.

A

B) the plasma portion increases more than the cellular portion.

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14
Q

The CNM/WHNP notes mild proteinurea (trace protein) reflected on the urine dipstick of a woman at a prenatal visit. What is the most appropriate response to this finding?

A) Continue providing routine care because this is a normal finding in pregnancy.
B) Draw labs to rule out preeclampsia.
C) Consult a nephrologist for additional screening for glomerular pathology.
D) Draw a catheterized specimen and send it to the lab for microscopic testing.

A

A) Continue providing routine care because this is a normal finding in pregnancy.

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15
Q

Which of the following maternal positions enhances water excretion?

A) Side lying
B) Sitting
C) Supine
D) Trendelenberg

A

A) Side lying

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16
Q

The CNM/WHNP is called to the ultrasound room because a woman was reporting feeling short of breath and suddenly became pale and diaphoretic during her ultrasound. What should the provider do first upon arriving in the room?

A) change the woman’s position to side-lying
B) give the woman a drink of juice
C) check the woman’s blood pressure
D) call 911 to have the woman transported to the hospital for further evaluation

A

A) change the woman’s position to side-lying

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17
Q

Which of the following hormones has thyroid stimulating (TSH)- like properties?

A) Human chorionic gonadotropin (HCG)
B) Estrogen
C) Progesterone
D) Luteinizing Hormone (LH)

A

A) Human chorionic gonadotropin (HCG)

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18
Q

Which process is unique to oogenesis?

A) Equal distribution of cytoplasm during meiosis I.
B) Meiosis for oogenesis begins after puberty.
C) Separation of chromosome pairs results in an oocyte and a polar body.
D) Oogenesis continues throughout the lifespan for each woman.

A

C) Separation of chromosome pairs results in an oocyte and a polar body.

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19
Q

The first functional organ in the embryo is the:

A) Brain
B) Liver
C) Intestines
D) Kidneys

A

A) Brain

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20
Q

Which of the following is responsible for the baseline fetal heart rate gradually becoming lower and lower from 16 weeks until term?

A) Hormonal alterations
B) Increasing size of fetus
C) Parasympathetic regulation
D) Maternal grand multiparity

A

C) Parasympathetic regulation

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21
Q

During placentation, trophoblastic tissue invades the maternal spiral arteries causing

A) Tightly coiled and elongated vessels
B) Increased responsiveness to adrenergic stimulation
C) Disruption of elastic and muscular properties in the vessel wall
D) Umbilical cord development

A

C) Disruption of elastic and muscular properties in the vessel wall

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22
Q

The preferred way to assess fundal height in the first trimester is:

A) bimanual exam
B) tape measure
C) finger breadths above the symphysis pubis
D) finger breadths below the umbilicus

A

A) bimanual exam

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23
Q

If not fertilized, the ovum usually lives for approximately _____ days.

A

1 day

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24
Q

Endocrine functions of the placenta include which of the following?

A) Synthesize hormones
B) Provide energy for developing fetus
C) Protect the fetus from pathogens
D) Move substances from maternal to fetal circulations

A

A) Synthesize hormones

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25
Q

During implantation, the products of conception attach to the maternal endometrium via invasion by the

A) Morula
B) Spiral arteries
C) Trophoblastic lacunae
D) Blastocyst

A

D) Blastocyst

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26
Q

An X-linked recessive disease can skip generations because

A) the disease is transmitted through female carriers.
B) females are hemizygous for the X chromosome.
C) mothers cannot pass X-linked genes to their sons.
D) these diseases need only one copy of the gene in females.

A

A) the disease is transmitted through female carriers.

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27
Q

Which process is unique to spermatogenesis?

A) Equal distribution of cytoplasm during meiosis I.
B) Synapsis during the zygotene stage.
C) Elongation of chromatids during the diplotene stage.
D) Degeneration of germ cells between fetal life and the onset of puberty.

A

A) Equal distribution of cytoplasm during meiosis I.

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28
Q

Which structure adheres to the endometrium and leads to the decidual reaction?

A) blastocyst
B) morula
C) zygote
D) zona pellucida

A

A) blastocyst

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29
Q

Which of the following is accurate regarding round ligament pain?

A) It starts around the 30th week of pregnancy
B) Relief can be obtained by stretching the front of the thigh
C) It often extends into the inguinal area
D) It is caused by the pressure from the broad ligaments impinging on the round ligaments

A

C) It often extends into the inguinal area

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30
Q

The fall in blood pressure seen in supine hypotensive syndrome is a direct result of:

A) decreased vascular resistance and vasoconstriction
B) decreased cardiac output
C) decreased heart rate

A

B) decreased cardiac output

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31
Q

Increased respiratory rate is caused by changes in the carbon dioxide threshold brought on by increases in

A) estrogen.
B) progesterone.
C) human chorionic gonadotropin.

A

B) progesterone.

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32
Q

Which of the following statements regarding nausea and vomiting of pregnancy is correct?

A) N&V of pregnancy rarely affects activities of daily living
B) N&V of pregnancy often resolves spontaneously at 12 to 14 weeks gestation
C) Pharmaceutical treatment is generally the best option for pregnant women
D) N&V of pregnancy can precipitate migraine headaches

A

B) N&V of pregnancy often resolves spontaneously at 12 to 14 weeks gestation

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33
Q

Which of the following statements is accurate regarding heartburn in pregnancy?

A) It is caused by increased GI motility
B) It is caused by an increase in progesterone
C) It is reduced by drinking cold liquids with a meal
D) It most often occurs at the start of the second trimester

A

B) It is caused by an increase in progesterone

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34
Q

Pregnant women are more prone to gingivitis because of swelling in their gums. The hormone that causes this is

A) human placental lactogen
B) estrogen
C) human chorionic gonadotropin

A

B) estrogen

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35
Q

Which of the following is NOT an appropriate relief measure for round ligament pain?

A) Resting in a hot tub
B) Applying warm compresses
C) Sitting down and leaning forward
D) Using Tylenol as needed

A

A) Resting in a hot tub

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36
Q

During pregnancy, the maternal hematocrit:

A) Increases
B) Decreases
C) Stays at pre-pregnancy levels

A

B) Decreases

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37
Q

Differential diagnoses to consider when a woman reports first trimester fatigue include:

A) depression and inadequate caloric intake
B) depression and anemia
C) insomnia and overworking herself at home
D) anemia and inadequate caloric intake

A

B) depression and anemia

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38
Q

Low back pain in pregnancy is exacerbated by?

A) Increasing round ligament pain
B) Dehydration
C) Lax abdominal muscles
D) Long periods of inactivity

A

C) Lax abdominal muscles

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39
Q

All of the following are appropriate measures to advise pregnant women with first trimester nausea except:

A) Eating sour foods or candies
B) Ginger tea
C) Vitamin B-12 50 mg PO BID
D) Brushing teeth several hours after eating

A

C) Vitamin B-12 50 mg PO BID

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40
Q

Appropriate advice for relieving leg cramps includes:

A) dorsiflexion of the foot and stretching the calf muscle
B) plantar flexion and increased dietary phosphorus
C) calcium supplements and resting the affected leg
D) applying heat and massage

A

A) dorsiflexion of the foot and stretching the calf muscle

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41
Q

Which of the following statements about hirsutism in pregnancy is accurate?

A) “If you notice the dark spots on your face increasing, using sun screen will help.”
B) “We don’t know why your nails change during pregnancy, but they usually get back to normal after delivery.”
C) “Stretch marks generally resolve soon after delivery.”
D) “Fine hairs usually go away after you have the baby, but the coarser ones might be there permanently.”

A

D) “Fine hairs usually go away after you have the baby, but the coarser ones might be there permanently.”

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42
Q

A pregnant woman calls to report her heart racing for several short periods of time today, and that she feels dizzy when this happens. What is the most appropriate advice?

A) Come in to the office for an evaluation
B) Take Tylenol for your symptoms
C) These symptoms are normal and are caused by an increase in blood volume.
D) Call 911 right away

A

A) Come in to the office for an evaluation

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43
Q

Which of the following is the correct over the counter remedy for nausea and vomiting?

A) Slippery Elm Bark tea
B) Vitamin B6 25 mg QID and ½ Unisom tablet
C) Vitamin B6 26 mg PO BID and 1 Unisom Capsule
D) Ginger 100 mg PO BID

A

B) Vitamin B6 25 mg QID and ½ Unisom tablet

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44
Q

During pregnancy, gastrointestinal motility is:

A) Unchanged
B) Decreased
C) Increased

A

B) Decreased

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45
Q

Dependent edema in pregnancy is associated with:

A) Fetal Growth Restriction (IUGR)
B) maternal obesity
C) frequently changing positions of legs
D) increased plasma albumin in pregnancy that increases osmotic pressure

A

B) maternal obesity

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46
Q

A 20 week pregnant woman presents to clinic reporting urinary frequency. The CNM/WHNP knows that urinary frequency in pregnancy:

A) generally gets progressively worse until delivery
B) is always a result of pressure on the bladder from the growing uterus
C) is worst in the first trimester of pregnancy
D) is diagnosed when the woman has more than 5 daytime voidings

A

A) generally gets progressively worse until delivery

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47
Q

A pregnant woman presents to clinic reporting constipation. Which of the following is NOT an appropriate first-line relief measure to suggest to her?

A) Take a stimulant laxative like Senekot as directed on the container.
B) Self administer a Fleets enema.
C) Increase intake of water and fruits and vegetables.
D) Take a bulk-forming laxative like Metamucil as directed on the container.

A

A) Take a stimulant laxative like Senekot as directed on the container.

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48
Q

A woman at 26 weeks gestation is experiencing heartburn. She has never had heartburn prior to this pregnancy and is asking you why this is occurring now. How will you explain the physiologic mechanism that produces heartburn during pregnancy?

A) Decreased gastric acid pH causes increased burning in the esophagus during pregnancy
B) The smaller stomach size delays gastric emptying during pregnancy causing more frequent heartburn
C) Relaxation of the lower esophageal sphincter makes pregnant women more prone to heartburn.

A

C) Relaxation of the lower esophageal sphincter makes pregnant women more prone to heartburn.

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49
Q

Tess is pregnant, at 26 weeks estimated gestational age, with her first baby. She has started prenatal and childbirth classes and is at a prenatal visit. She feels well, her baby is active, and her pregnancy has been uncomplicated. Her blood pressure is 96/60 mm Hg and the fetal heart rate is 134 beats per minute. The medical assistant has offered Tess 50 g of dextrose for gestational diabetes screening and she declined it. She tells Amy, the midwife, she rarely eats things with added sugar, so she does not think it’s possible for her to have excess sugar in her system. She reports occasional sharp pains in her groin when she’s active and aching in her lower back when she sits for a long time, but thinks it’s probably normal. She asks if her blood pressure is okay because it has never been this low before. She is also interested in recommendations for iron supplements because her childbirth instructor told her she might need one.

What is the best way for Amy to respond to Tess having declined her gestational diabetes screening?

A) Ask Tess to provide a 3-day diet recall and assess whether her intake of other carbohydrates places her at risk for altered glucose metabolism.
B) Explain that the placenta produces a hormone that changes the way she processes carbohydrates, causing more sugar than usual to be in her bloodstream.
C) Tell Tess that this is reasonable because the mother’s sugar consumption is the primary determinant of her metabolic function in pregnancy.
D) Explain that the baby produces its own sugars that cross the placenta, so even a normal amount in her bloodstream can cause her to produce excess insulin.

A

B) Explain that the placenta produces a hormone that changes the way she processes carbohydrates, causing more sugar than usual to be in her bloodstream.

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50
Q

The position where blood pressure is the lowest for a pregnant woman is:

A) side lying
B) standing
C) sitting

A

A) side lying

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51
Q

During pregnancy, stomach motility:

A) Is unchanged
B) Changes depending on gestational age
C) Decreases
D) Increases

A

C) Decreases

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52
Q

A pregnancy is maintained through hormones produced by the:

A) egg sac and placenta
B) corpus luteum and chorion.
C) corpus luteum and placenta.
D) ovary and placenta

A

C) corpus luteum and placenta.

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53
Q

The sensation of “prickly heat” experienced by some women in pregnancy is related to which of the following:

A) eccrine sweat gland activity
B) palmar erythema
C) the presence of epulis
D) apocrine sweat gland activity

A

A) eccrine sweat gland activity

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54
Q

Which of the following changes occurs in the cardiovascular system during pregnancy?

A) Decreased blood volume
B) Decreased skin perfusion
C) Increased pulmonary vascular resistance
D) Decreased systemic vascular resistance

A

D) Decreased systemic vascular resistance

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55
Q

Which of the following physiologic factors influences respiration in late pregnancy?

A) Increased subcostal angle
B) Tightening of the ligaments between the ribs decreasing rib elasticity
C) The major work of respiration is accomplished by the costal muscles in late pregnancy
D) Dropping of the diaphragm to 4 cm below its original position

A

A) Increased subcostal angle

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56
Q

Every pregnant woman with pruritus should have an evaluation of which of the following:

A) white blood cell count
B) ultrasound of the fetus
C) hemoglobin electorophoresis
D) liver function tests

A

D) liver function tests

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57
Q

Which of the following is NOT a reason for decreased total body iodine pool in pregnancy?

A) Decreased absorption of iodine by the small intestine
B) Placental transfer of iodine to the fetus
C) Increased renal iodide loss due to increased renal blood flow
D) Increased renal iodide loss due to increased glomerular filtration rate

A

A) Decreased absorption of iodine by the small intestine

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58
Q

T/F: Immune factors that prevent maternal rejection of the fetus also protect the placenta from infectious agents such as viruses and bacteria.

A

True

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59
Q

A systolic murmur at the left sternal border, third intercostal space occurs:

A) due to mitral stenosis that is worsened in pregnancy
B) due to damage of the pulmonic valve from the increased blood volume of pregnancy
C) rarely and is usually heard in obese women due to the extra cardiac workload associated with obesity
D) commonly during pregnancy, and expected to be present until delivery

A

D) commonly during pregnancy, and expected to be present until delivery

Varney p. 651 “Systolic ejection murmur that is loudest along the left sternal boarder is a common finding in pregnant women and is attributed tot he dramatic increase in cardiac output.”

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60
Q

SATA: Inflammation at the maternal-placental interface is most marked in which trimester(s)?

A) First trimester
B) second trimester
C) third trimester

A

A) First trimester
C) third trimester

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61
Q

Alterations in skin pigmentation during pregnancy are thought to be related to which of the following?

A) cutis marmorata
B) the effects of estrogen and progesterone on melanocytes
C) alterations in the dermal support matrix
D) decreased capillary integrity

A

B) the effects of estrogen and progesterone on melanocytes

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62
Q

Which of the following statements about iodine deficiency is false?

A) Iodine deficiency is associated with increase risk of miscarriage.
B) Iodine deficiency is the most frequent cause worldwide of preventable mental retardation.
C) Iodine deficiency is associated with increased risk of stillbirth.
D) The United States has more iodine deficient pregnant women than Europe or Southeast Asia.

A

D) The United States has more iodine deficient pregnant women than Europe or Southeast Asia.

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63
Q

Which of the following is true about thyroid hormones in pregnancy?

A) They decrease by 50%
B) They increase in availability by 40-100%
C) They remain stable until the third trimester
D) They are not essential to fetal growth

A

B) They increase in availability by 40-100%

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64
Q

Which of the following is the most common contributor to the classification of pregnancy dermatoses called Atopic eruption of pregnancy (AEP)?

A) Eczema in pregnancy
B) Prurigo of pregnancy
C) PUPPPs
D) Pruritic folliculitis of pregnancy

A

A) Eczema in pregnancy

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65
Q

Changes in hair growth during pregnancy are influenced by which of the following hormones?

A) Estrogen
B) Progesterone
C) Human Chorionic Gonadotroin (HCG)
D) Human Placental Lactogen (HPL)

A

A) Estrogen

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66
Q

T/F: Thyroid disorders are the most common endocrine disorders seen in pregnancy.

A

False

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67
Q

T/F: Maternal chemotaxis is increased during pregnancy to allow the mother to quickly respond to infection exposure.

A

False

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68
Q

Which of the following is the most appropriate advice to give to women who report feeling their heart “flip-flopping” without other accompanying symptoms?

A) “Having palpitations is likely due to the added life stressors associated with being pregnant.”
B) “You need to schedule a cardiology consult as soon as possible.”
C) “The increase in blood volume during pregnancy is likely responsible for this symptom.”
D) “Palpitations are caused by increased estrogen during pregnancy and are normal.”

A

C) “The increase in blood volume during pregnancy is likely responsible for this symptom.”

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69
Q

Nausea and vomiting in pregnancy has been correlated with which of the following?

A) Increased estrogen levels
B) Decreased prolactin levels
C) Alterations in thyroid hormones
D) Iodine deficiency

A

C) Alterations in thyroid hormones

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70
Q

T/F: A semiallograft is a foreign tissue from the same species but with a different antigenic makeup.

A

True

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71
Q

Which placental hormone is responsible for an anti-insulin (diabetogenic) action that leads to increased maternal insulin needs?

A) progesterone
B) Gonadotropin-Releasing Hormone
C) estrogen
D) human placental lactogen

A

D) human placental lactogen

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72
Q

Pregnancy rhinitis is most appropriately first treated with which of the following?

A) saline nasal spray
B) topical sympathomimetic nasal sprays
C) systemic antihistamines
D) tylenol

A

A) saline nasal spray

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73
Q

The observable characteristics of an individual are called his/her:

A) phenotype
B) genotype
C) karyotype
D) mitochondrial inheritance

A

A) phenotype

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74
Q

A 4 year old girl has a karyotype that reveals an absent homologous X chromosome with only a single X chromosome present. Her condition is called

A) Down syndrome.
B) Klinefelter syndrome.
C) Turner syndrome.
D) Edward syndrome.

A

C) Turner syndrome.

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75
Q

Each parent contributes exactly one set of chromosomes to each of their children. These chromosomes:

A) are randomly selected from the parent’s two sets of chromosomes, so each of their children inherit a unique set of chromosomes
B) are selected in an organized fashion that results in a predictable chromosomal inheritance from each parent
C) are randomly selected from the parent’s chromosomes, but this selection process repeats itself so that each child receives a matching set of chromosomes
D) combine to result in children inheriting identical traits as their parents

A

A) are randomly selected from the parent’s two sets of chromosomes, so each of their children inherit a unique set of chromosomes

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76
Q

A woman presenting for care at 10 weeks gestation says she desires genetic screening for “everything that I can screen for.” Which of the following screening test should the clinician recommend?

A) integrated screen
B) non-invasive prenatal testing (NIPT)
C) quad screen
D) carrier screen

A

A) integrated screen

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77
Q

Which of the following are examples of types of traits?

A) one’s hair color, eye color, and height
B) an individual’s behavioral characteristics
C) an individual’s risk of getting cancer or certain types of mental illness
D) all of these are types of traits

A

D) all of these are types of traits

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78
Q

Which of the following statements is TRUE?

A) Chromosomes are comprised of proteins that store DNA.
B) Two sets of 22 chromosomes are contained in each human cell.
C) Females are more likely to inherit X-linked disorders than are males.
D) Each strand of human DNA contains one gene.

A

A) Chromosomes are comprised of proteins that store DNA.

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79
Q

Which of the following is an accurate statement about cystic fibrosis (CF) screening?

A) All women should be offered CF screening so those with a positive screen can take advantage of prenatal treatment strategies for CF.
B) Carriers of CF are at risk for pyelonephritis.
C) If both a mother and father have the CF gene, the risk of cystic fibrosis disease in the fetus is 50%.
D) CF screening should be offered to all women at the first prenatal visit and is usually done via a blood draw.

A

D) CF screening should be offered to all women at the first prenatal visit and is usually done via a blood draw.

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80
Q

Which of the following screening tests has the lowest detection rate for Down Syndrome?

A) Integrated screening
B) Cell-free DNA testing (NIPT)
C) First trimester Screening
D) Quad screen

A

D) Quad screen

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81
Q

A woman has a negative cystic fibrosis (CF) screening test. Which of the following is true?

A) There is no chance that the woman could have a baby with CF.
B) The baby’s father would have to be screened to accurately determine the risk of having a baby with CF.
C) Although the risks are decreased with a negative screening test, there is still a chance that her baby could have CF.
D) There is still an 8% chance that the baby could have CF, even after a negative screening test.

A

C) Although the risks are decreased with a negative screening test, there is still a chance that her baby could have CF.

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82
Q

A 32 yo G1P0 Caucasian American presents to your office for her first prenatal visit at 8 weeks gestation by LNMP. Appropriate genetic screening tests to discuss and offer to her as choices include:

A) Chorionic villi sampling (CVS) and quad screen
B) Quad screen and hgb electrophoresis
C) HIV testing and nuchal translucency ultrasound
D) Integrated screening and cystic fibrosis screening

A

D) Integrated screening and cystic fibrosis screening

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83
Q

A woman presents for prenatal care. She informs the CNM/WHNP that she does not want screening for cystic fibrosis (CF) because her other children do not have it and she and her husband are healthy. What is the most appropriate response?

A) “You’re correct- you don’t need testing since your other children have been unaffected and you and your husband are unaffected.”
B) “Each pregnancy carries a 25% chance of having a child with CF if you and your husband are carriers, regardless of whether or not your other children are affected.”
C) “There is a 25% chance that you could have a child who is a CF carrier if you and your husband are CF carriers. You can be carriers of the CF gene and not know it.”
D) “Because your age increases with each pregnancy, your risk of CF increases with each pregnancy also.”

A

B) “Each pregnancy carries a 25% chance of having a child with CF if you and your husband are carriers, regardless of whether or not your other children are affected.”

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84
Q

A 35 year old G2P1001 at 15 weeks and 5 days by LMP chose to have a quad screen drawn. After speaking with her regarding the elevated AFP value, the CNM/WHNP appropriately orders:

A) supplementation with folic acid and ferrous sulfate
B) an abdominal ultrasound for confirmation of dating
C) a vaginal ultrasound for measurement of nuchal translucency
D) an amniocentesis

A

B) an abdominal ultrasound for confirmation of dating

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85
Q

An example of a multifactoral disorder that does not follow clear-cut modes of inheritance but does seem to “run is families” is

A) Angelman Syndrome.
B) high blood pressure.
C) cystic fibrosis.
D) Huntington Disease.

A

B) high blood pressure.

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86
Q

A woman presents for her first prenatal visit at 8 weeks gestation and tells the CNM/WHNP that she has heard that she can have an early ultrasound to “measure the baby’s neck and find out if the baby is normal”. She shares that she would like this test because she is afraid of needles and would like to minimize blood draws in pregnancy. Which of the following is the most appropriate response to this woman?

A) “Being pregnant means that you’ll have to have quite a few blood draws, so what’s one more?”
B) “The chances of detecting an abnormality by first trimester ultrasound measurement of nuchal translucency alone are approximately 75%. If you add blood testing, your chances of detecting a problem can increase to 95%.”
C) “The chances of finding out if your baby has an anomaly by ultrasound alone are high enough that if you decide not to have any additional blood draws, you will still get similar information than if you did choose to have the blood draws.”
D) The chances of seeing an abnormality on ultrasound are 90%. The chances of finding a problem with the ultrasound and blood draw together are 95%.”

A

B) “The chances of detecting an abnormality by first trimester ultrasound measurement of nuchal translucency alone are approximately 75%. If you add blood testing, your chances of detecting a problem can increase to 95%.”

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87
Q

A woman presents for prenatal care and desires screening for cystic fibrosis (CF). The test results show that she is a CF carrier. She is unsure of the paternity of her baby. Which of the following is the most appropriate management plan?

A) Suggest an amniocentesis since the baby’s father is unavailable for testing.
B) Offer paternity testing for the woman’s past partners to determine paternity so that the father may be screened.
C) Offer an appointment with a genetic counselor.
D) Reassure the patient that she is likely to have an unaffected baby because the chances that both she and the baby’s father have the same genetic CF mutation are slim.

A

C) Offer an appointment with a genetic counselor.

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88
Q

Which of the following is considered an epigenetic event?

A) predisposition to diabetes mellitus type 1
B) inheritance of autosomal dominant gene
C) genomic imprinting
D) trisomy 21 due to deletion

A

C) genomic imprinting

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89
Q

All of the following are true statements about non-invasive prenatal testing (NIPT) EXCEPT:

A) NIPT has a detection rate of approximately 98%.
B) NIPT has a false positive rate of approximately 0.5%.
C) NIPT offers the ability to detect multiple aneuploidy conditions.
D) The current standard of practice in all settings is to offer NIPT to all women.

A

D) The current standard of practice in all settings is to offer NIPT to all women.

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90
Q

To exhibit a recessive phenotype, an individual must generally have:

A) two dominant alleles
B) one dominant and one recessive allele
C) two recessives alleles
D) it is impossible to predict which phenotype a person will have

A

C) two recessives alleles

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91
Q

Primary prevention is possible for which of the following conditions?

A) Trisomy 13
B) Neural Tube Defects
C) Cystic Fibrosis
D) Down Syndrome

A

B) Neural Tube Defects

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92
Q

A woman is considering diagnostic prenatal testing and asks the CNM/WHNP about the safety of the procedure. The CNM/WHNP replies: “While the risk of procedure-related fetal loss associated with invasive diagnostic testing can vary by clinic, the most frequently quoted overall risk is”:

A) 1 in 300 to 1 in 500.
B) 1 in 100 to 1 in 200.
C) 1 in 1000.
D) 1 in 500 to 1 in 700.

A

A) 1 in 300 to 1 in 500.

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93
Q

A person’s karyotype shows 47 autosomes and two X chromosomes. What is the best interpretation of this karyotype? The karyotype is

A) aneuploid and the individual is male.
B) euploid and the individual is male.
C) aneuploid and the individual is female.
D) euploid and the individual is female.

A

C) aneuploid and the individual is female.

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94
Q

Identical twins have the same genome but often develop differently. For instance, one may develop arthritis and the other does not. The best explanation is:

A) different gene patterns.
B) environmental factors that affect the epigenome.
C) telomere loosening.

A

B) environmental factors that affect the epigenome.

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95
Q

SATA: Which of the following tests should be offered to all pregnant women?

A) Screening for Down’s Syndrome
B) Hemoglobin electrophoresis
C) Hepatitis B e antigen level (HBeAG)
D) Chorionic villi sampling (CVS)

A

A) Screening for Down’s Syndrome
B) Hemoglobin electrophoresis

Varney 6 e p. 680 Panethnic screening refers to offering carrier screening to all individuals regardless of race or ethnicity.

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96
Q

Most women who have an abnormal quad screen result:

A) will have a baby with a neural tube defect.
B) will have a normal fetus.
C) should have serial ultrasounds and doppler velocimetry screening in the third trimester.
D) should have a repeat quad screen in 2 weeks.

A

B) will have a normal fetus.

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97
Q

Which aneuploidy disorder has no noticeable phenotype at birth?

A) Klinefelter Syndrome (47, XXY)
B) Edwards Syndrome (Trisomy 18)
C) Downs Syndrome (Trisomy 21)
D) Turner Syndrome (45, X)

A

A) Klinefelter Syndrome (47, XXY)

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98
Q

Cystic fibrosis carrier screening should be offered:

A) To all African American women.
B) Ideally at 10-12 weeks gestation.
C) To all women, regardless of ethnicity.
D) Only to Caucasian women.

A

C) To all women, regardless of ethnicity.

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99
Q

A woman presenting for care at 10 weeks gestation says she desires genetic screening for “everything that I can screen for.” Which of the following screening test should the clinician recommend?

A) integrated screen
B) non-invasive prenatal testing (NIPT)
C) quad screen
D) carrier screen

A

A) integrated screen

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100
Q

Meiosis results in daughter cells that have:

A) 23 chromosomes
B) 44 genes and 2 sex chromosomes
C) 21 autosomes and 2 sex chromosomes
D) 46 chromosomes

A

A) 23 chromosomes

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101
Q

What is an allele?

A) Homozygous proteins
B) Genetic information for the form a trait will take
C) Sets of chromosome reactions

A

B) Genetic information for the form a trait will take

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102
Q

Which of the following statements is true concerning triploidy?

A) triploidy involves an extra copy of one chromosome
B) triploidy involves an extra copy of every chromosome
C) triploidies are never fatal
D) triploidies occur when one ovum is fertilized by one sperm

A

B) triploidy involves an extra copy of every chromosome

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103
Q

Which of the following is accurate information to give women about first trimester genetic screening?

A) “This screening does not screen for neural tube defects.”
B) “If the alpha-fetoprotein (AFP) component is elevated, an amniocentesis is advised.”
C) “The optimal time for screening is between 8 and 10 weeks gestation.”
D) “This screening has a 70% Down Syndrome detection rate.”

A

A) “This screening does not screen for neural tube defects.”

Jordan, p. 184. 1st trimester screen includes: NT + PAPP-A+ hCG. (It does not check AFP). The first-trimester screen does not include AFP, and therefore cannot detect NT defects on its own. Jordan, p. 184. The first-trimester screen involves a Blood test at 9 weeks and NT between 11-13. The first-trimester screen detects 82-87% of DS. Jordan, p. 184.

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104
Q

A woman presents for prenatal care and desires screening for cystic fibrosis (CF). The test results show that she is a CF carrier. She is unsure of the paternity of her baby. Which of the following is the most appropriate management plan?

A) Suggest an amniocentesis since the baby’s father is unavailable for testing.
B) Offer paternity testing for the woman’s past partners to determine paternity so that the father may be screened.
C) Offer an appointment with a genetic counselor.
D) Reassure the patient that she is likely to have an unaffected baby because the chances that both she and the baby’s father have the same genetic CF mutation are slim.

A

C) Offer an appointment with a genetic counselor.

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105
Q

A mother is a carrier for hemophilia (x-linked recessive) and the father is a hemophiliac. What are the chances of an offspring being a hemophiliac? _____%

A

50%

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106
Q

Why are X-linked recessive disorders expressed in males more frequently than females?

A) Females have more effective DNA repair mechanisms than do males.
B) Expression of genes from the Y chromosome does not occur in females.
C) One X chromosome of a pair is always inactive in all female cells.
D) X chromosomes always carry the trait and males only have one X chromosome.

A

D) X chromosomes always carry the trait and males only have one X chromosome.

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107
Q

What is a trait?

A) A feature in a person passed generation to generation
B) A gene that has been changed
C) Messenger protein

A

A) A feature in a person passed generation to generation

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108
Q

When a child inherits an autosomal recessive disorder, it is inherited it from their

A) mother.
B) father.
C) mother and father.

A

C) mother and father.

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109
Q

A pregnant woman and her husband are both cystic fibrosis (CF) carriers. What is the likelihood and rationale for their having a child without CF?

A) 25%; because 75% have CF
B) 75%; because only 25% have CF
C) 80%; if both parents are in good health
D) 85-90%; if the anatomy ultrasound is negative for CF markers

A

B) 75%; because only 25% have CF

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110
Q

Which of the following tests is preferred to offer to women who desire to screen for both Down Syndrome and neural tube defects (NTD)?

A) Nuchal translucency ultrasound
B) Quad screen
C) First trimester screening
D) Triple screen

A

B) Quad screen

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111
Q

Which of the following is the best statement to use when explaining the risk of Down Syndrome to women? (For purposes of this question, assume that the woman has a 1:100 risk of Down Syndrome).

A) “The relative risk that your baby will have Down Syndrome is lower than the risk of it having a Neural Tube Defect.”
B) “The chance that your baby will have Down Syndrome is less than 2 percent.”
C) “The chance that your baby will have Down Syndrome is 1 in 100, and there is a 99% likelihood that your baby will be normal.”
D) “The chance that your baby will have Down Syndrome is 1 in 100, and that he or she will not is 99 in 100.”

A

D) “The chance that your baby will have Down Syndrome is 1 in 100, and that he or she will not is 99 in 100.”

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112
Q

A low-risk woman and her partner, both of whom have a negative personal and family genetic history, present for prenatal care at 11 5/7 weeks gestation by uterine size and LMP. If the woman and her partner request screening, which of the following would be most appropriate to schedule at that first visit?

A) Neural tube defects (NTDs) screening with Chorionic Villus Sampling (CVS)
B) Down Syndrome screening with an integrated screening method
C) Fragile X Syndrome screening with a blood draw
D) Down Syndrome screening with a quad screen blood draw

A

B) Down Syndrome screening with an integrated screening method

The integrated screen is a blood test at 10-13 weeks, NT at 11-14 weeks, and a 2nd blood test at 15-22 weeks. This test provides the highest sensitivity with the lowest false positive rate of the universally offered screening choices. 96% detection rate. Jordan p. 184 & 185

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113
Q

What genetic process is likely responsible for the occurrence of asthma in only one of a pair of twins?

A) epigenetic modifications
B) transgenerational inheritance
C) homoplasty
D) genomic imprinting

A

A) epigenetic modifications

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114
Q

Which of the following conditions is NOT an aneuploidy condition?

A) Turner Syndrome
B) Trisomy 18
C) Down Syndrome
D) Cystic Fibrosis

A

D) Cystic Fibrosis

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115
Q

Imprinting affects gene expression through:

A) Epigenetic control
B) Neural mechanisms
C) Changing DNA structure
D) Meiosis

A

A) Epigenetic control

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116
Q

Which of the following women has the highest chance of being a cystic fibrosis (CF) carrier?

A) a 20 year old Caucasian woman
B) A 40 year old Hispanic woman
C) A 30 year old African woman
D) All women have the same chance of being a CF carrier

A

A) a 20 year old Caucasian woman

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117
Q

Pregnancy-associated plasma protein A (PAPP-A) is a:

A) Protein secreted by the trophoblast
B) Genetic substance produced by the placenta
C) Glucose molecule secreted by the maternal decidua
D) Protein secreted by the uterus

A

A) Protein secreted by the trophoblast

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118
Q

Characteristics of X-linked recessive disorders include which of the following?

A) All daughters of affected fathers are carriers.
B) Boys and girls are equally affected.
C) The son of a carrier mother has a 25% chance of being affected.
D) Affected fathers transmit the gene to all of their sons.

A

A) All daughters of affected fathers are carriers.

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119
Q

People who have neurofibromatosis will show varying degrees of the disease. This is related to the genetic principle of

A) penetrance.
B) expressivity.
C) dominance.
D) recessiveness.

A

B) expressivity.

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120
Q

A woman presents for prenatal care at 7 weeks gestation. While taking her family history, the woman mentions that she has a brother who has developmental delays and she does not know the reason. Which of the following would be most important to include in the care plan for this woman at this visit?

A) referral to a genetic counselor
B) scheduling first trimester nuchal translucency and serum screening
C) scheduling an ultrasound for genetic anatomy screening
D) reinforcing the need to attend all prenatal visits so she can get the appropriate lab tests at the appropriate time

A

A) referral to a genetic counselor

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121
Q

During a 20 week anatomy ultrasound a meningomyelocele is found. The clinician explains that this is a type of spina bifida where

A) a sac of spinal fluid with part of the spinal cord or nerve root and meninges herniates through an opening in the baby’s back.
B) a sac of spinal fluid containing meninges herniates through an opening in the baby’s back. The sac doesn’t contain the spinal cord or nerve roots.
C) there is a small gap in the spine but no opening or sac on the baby’s back.

A

A) a sac of spinal fluid with part of the spinal cord or nerve root and meninges herniates through an opening in the baby’s back.

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122
Q

A 22 year old G1P0 at 11 weeks gestation presents to clinic for her second prenatal visit. Her Cystic Fibrosis (CF) screen came back positive. Which of the following is most appropriate to include in her care plan?

A) Advise her to have an amniocentesis for a definitive diagnosis.
B) Advise her to have the baby’s father tested for CF carrier status.
C) Tell her she has a 1 in 4 chance of having a baby with CF.
D) Schedule an ultrasound.

A

B) Advise her to have the baby’s father tested for CF carrier status.

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123
Q

Which of the following statements regarding integrated genetic screening is accurate?

A) Women under the age of 25 don’t need to be offered this testing
B) The false positive rate is approximately 15%
C) It is 95% accurate for detecting Down Syndrome in the fetus
D) Its components are 1st trimester fetal anatomy ultrasound and 2nd trimester serum screening

A

C) It is 95% accurate for detecting Down Syndrome in the fetus

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124
Q

Non-disjunction that leads to trisomy 21 occurs most often among women aged:

A) 35 and older.
B) 20-25.
C) 26-31.
D) Under 20.

A

A) 35 and older.

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125
Q

The most sensitive traditional screening test for Down Syndrome is:

A) nuchal translucency ultrasound
B) combined first trimester screening
C) integrated screening
D) quad screen

A

C) integrated screening

BE CAREFUL: There is a test that has a higher rate of detecting DS, that is the NIPT at 99%. However, it wasn’t an option here. So, integrated is the highest, WHEN COMPARED to the other 3 choices there. But not the ABSOLUTE highest! Be careful with memorizing quiz questions as a fact. They are always in relation to the other 3 distractors.

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126
Q

Alpha fetoprotein (AFP) levels in maternal serum is used to screen for:

A) Neural tube defects
B) Down Syndrome
C) Cystic Fibrosis
D) Trisomy 18

A

A) Neural tube defects

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127
Q

Nuchal translucency measures thickness of the nape of the neck that is due to:

A) Excess accumulated fluid
B) Genetic disorders
C) Placental insufficiency
D) Neural tube malformation

A

A) Excess accumulated fluid

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128
Q

A 25 year old G2P0010 at 18 weeks gestation presents to clinic for her routine prenatal visit. During the visit she tells you that although she had initially declined genetic screening, she has since changed her mind and would like to have genetic screening done after all. Which of the following tests would you suggest she have?

A) sequential screen
B) non-invasive prenatal testing (NIPT)
C) integrated screen
D) ultrasound

A

B) non-invasive prenatal testing (NIPT)

10 weeks through term. Trisomy 13, 18, 21. Detection 99%. Highest rate of detection for DS.

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129
Q

A father is affected by an autosomal dominant disease, but the mother does not have the disease gene. One of their children has the disease. What is the risk percentage for future offspring?

A) 50%
B) 33%
C) 25%
D) impossible to determine

A

A) 50%

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130
Q

An individual’s expression of a single-gene trait is called

A) phenotype.
B) karyotype.
C) genotype.
D) dominant trait.

A

A) phenotype.

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131
Q

A 5% false positive rate means that:

A) 95% of women who have the test have a normal fetus
B) 5% of women who have the test have a positive test and a normal fetus
C) 5% of women have a positive test and most have an abnormal fetus.
D) 5/1000 women will have a positive test and a normal fetus

A

B) 5% of women who have the test have a positive test and a normal fetus

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132
Q

A patient presents for a visit reporting infertility. She has one ten year old child born at 28 weeks. In the past ten years, she has lost three pregnancies in the first trimester and given birth to one child at 22 weeks who lived for two days. Her gravida & parity status is:

A

G5 P0231

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133
Q

A woman had a viable 37 3/7 week infant (currently alive and well), a 26 week infant who was stillborn, a 6-week miscarriage, and a 34 week live infant (currently alive and well). She is currently pregnant with twins. Her gravida and parity status is:

A

G5P1212

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134
Q

A pregnant woman presents to clinic with her two year old twins born at 35 weeks gestation and her 1 year old son born at 38 weeks gestation. She reports she she had a stillborn infant born at 24 weeks, and reports the death of an infant born at 25 weeks that lived for one day five years ago. She has had one other ectopic pregnancy. What is her G & P status?

A

G6 P1313

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135
Q

When establishing gravid and parity status, any fetus delivered between 20 0/7 and 36 6/7 weeks is counted in which place of the G/P’s?

A

P (preterm)

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136
Q

A pregnant woman has had one 2 year old born at 39 weeks gestation, a 4 year old born at 41 weeks gestation and has had one spontaneous loss at 7 weeks gestation. Her gravida & parity status is:

A

G4P2012

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137
Q

A 33 year old presents to the prenatal clinic with her 5 year old who was born at 38 weeks and one of her twins who was born at 35 weeks (the other one died at 3 days of life). She also reports one spontaneous pregnancy loss at 6 weeks gestation. Her gravida & parity status is:

A

G4 P1112

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138
Q

A 24 year old woman has just arrived for her first prenatal visit with her 7 year old twins born at 35.6 weeks gestation and her 2 year old born at 38.3 weeks gestation. She had one spontaneous miscarriage at 7 weeks gestation. Her gravida and parity status is:

A

G4P1113

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139
Q

A woman presents today at the office for her first prenatal visit. She indicates that she had a normal period 8 weeks ago: her periods are regular and occur every 28 days. She voices concern about one episode of intermittent pink spotting that she had for a few hours about 6 weeks ago, with no spotting or symptoms since. How many weeks gestation is she likely to be?

A

8 weeks gestation

Because her periods are regular and occur every 28 days and she is sure that her last period occurred 8 weeks ago, she is likely 8 weeks pregnant. The spotting she reports was likely implantation spotting.

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140
Q

When discussing pregnancy dating, which is the correct terminology used to describe gestational age?

A) gestational weeks (also called menstrual weeks)
B) trimesters
C) months since conception
D) post conceptual weeks (weeks since conception)

A

A) gestational weeks (also called menstrual weeks)

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141
Q

A 22 year-old G1P0 arrives to clinic for her 1st prenatal visit. She thinks her last period started “around 7 weeks ago”. What is the most appropriate question for the midwife to next ask her in order to establish the EDB?

A) Were you planning on getting pregnant around this time?
B) Was your last period normal for you?
C) Do you keep track of the dates of your periods on a calendar or in an app?
D) What type of birth control were you using around that time, if any?

A

C) Do you keep track of the dates of your periods on a calendar or in an app?

It is important to ascertain the exact day that her last period started to accurately establish the EDB. Many women keep track of this on a calendar or in an app. When encountering a woman who does not know the date of her LMP, it may useful to use “memory joggers” to help her recall the date. Although it is important to take a menstrual history, without the date of her LMP the midwife would be unable to establish the EDB at this visit and would order an ultrasound to date the pregnancy. Knowing Tina’s reproductive plans or type of birth control would be useful to discuss after trying to determine the EDB.

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142
Q

The criterion measurement to date a pregnancy during the first trimester is:

A

crown-rump length

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143
Q

Which of the following things is LEAST likely to confuse the process of dating a first trimester pregnancy?

A) oligohydramnios
B) bladder status
C) uterine position
D) maternal habitus

A

A) oligohydramnios

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144
Q

A woman is at the clinic today for her first prenatal visit. She does not recall her LMP. Her uterus is approximately 2 finger breadths above the symphysis pubis. Based upon these examination findings, the midwife would estimate her gestational age as:

A) approximately 14 weeks gestation
B) unable to determine until Dee has an ultrasound
C) approximately 16 weeks gestation
D) approximately 12 weeks gestation

A

A) approximately 14 weeks gestation

At 14 weeks, the uterus is located approximately 2 finger breadths above the symphysis pubis. The uterus becomes an abdominal organ at 12 weeks, and is usually found at the level of the umbilicus at 20 weeks.

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145
Q

In clinic, a woman tells you she thinks her period was about 10 weeks ago. Her menstrual history includes menses interval of 28-29 days, and she occasionally skips several periods a year. What is the best way to date her pregnancy?

A) With presumptive signs and uterine size
B) Vaginal ultrasound
C) Naegele’s rule
D) Serum beta Hcg

A

B) Vaginal ultrasound

Correct! Because she has an unknown LMP and irregular menses including skipping cycles, a vaginal ultrasound is the appropriate way to date her pregnancy. Presumptive signs of pregnancy may be caused by other conditions; and while uterine size correlates with gestational age, it is most helpful in dating pregnancies in the presence of certain LMP. It is inappropriate to use Naegele’s rule in cases where a woman has irregular periods, which includes skipping periods. Serum beta Hcg is helpful for dating pregnancy only when there are 2 values less than 10,000 collected one week apart and rising appropriately, but this is still less accurate than a first trimester ultrasound.

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146
Q

A woman presents to clinic 7 days after missing her expected menstrual period. She reports using a home pregnancy test the day after she expected her period, but it was negative. The next best step for the CNM/WHNP to take is to:

A) consult the OB for a progesterone prescription to induce menses
B) order an abdominal ultrasound
C) draw a quantitative beta hCG level
D) repeat a urine pregnancy test

A

D) repeat a urine pregnancy test

She took the pregnancy test 1 day after missing her period. It is possible that it was too early to detect hCG in the urine. The priority action is to repeat the urine hCG. (Varney pg: 699 - A great deal of discrepancy exists in the actual detection rates for specific commercial products. Furthermore, the concentration of beta-hCG in urine can vary within the same woman throughout the day depending on fluctuations in urine concentration. )

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147
Q

A woman presents to clinic today for her first prenatal visit. She thinks her LMP was about 12 weeks ago, but cannot remember a specific date. On bimanual exam, the midwife/WHNP finds her uterus to be slightly enlarged and globular shaped, located below the symphysis pubis. The best way to date her pregnancy is:

A) vaginal ultrasound
B) abdominal ultrasound
C) Naegle’s rule and presumptive signs of pregnancy
D) presumptive and positive pregnancy signs

A

A) vaginal ultrasound

Based upon the size of her uterus, she is likely in her first trimester. Because she cannot remember her LMP, a vaginal probe ultrasound is indicated for pregnancy dating.

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148
Q

Which of the following is an accurate statement regarding serum beta hCG levels?

A) they peak at 10 weeks and are used primarily to corroborate pregnancy dating
B) they peak between 8.5-10 weeks and double in value every 48 hours
C) they peak between 6-10 weeks and double in value every 24 hours
D) they peak between 9-11 weeks and increase exponentially over the next 6 weeks

A

B) they peak between 8.5-10 weeks and double in value every 48 hours

Beta hCG is detectable 8-11 days after conception and doubles every 2 days until it peaks at 10 weeks gestation then rapidly declines between 12 and 16 weeks gestation.

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149
Q

A 34 year old G1 being seen in clinic for her first prenatal visit states her LMP was 8 weeks ago and was normal. When performing a bimanual exam, the midwife/WHNP determines that her uterus is enlarged to about 10 week size. Which one of the following is NOT a possible reason for this clinical finding?

A) uterine fibroids
B) fetal position
C) multiple gestation
D) error in dating

A

B) fetal position

At this gestation, fetal position does not affect uterine size while uterine fibroids, multiple gestation, and errors in dating do.

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150
Q

When deciding whether or not to adopt a clinic-wide policy of routine first trimester ultrasound for dating purposes, the CNM/WHNP should consider:

A) in general, women can’t be relied upon to provide an accurate LMP date.
B) second trimester ultrasounds can provide reasonably accurate dating confirmation along with a fetal anatomic assessment
C) second trimester ultrasounds are not valuable at all for dating purposes
D) since it’s culturally acceptable to have multiple ultrasounds in pregnancy, it’s best to do what the individual woman wants to do

A

B) second trimester ultrasounds can provide reasonably accurate dating confirmation along with a fetal anatomic assessment

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151
Q

The most common reason for a size/dates discrepancy in the first trimester is:

A

an uncertain LMP

Williams Obstetrics 26th e p. 247 “If the LMP is certain, the EDD is based on LMP unless the date-measurement discrepancy exceeds set thresholds.”

If the GA is less than 9 weeks and the CRL and LMP dates are off by more than 5 days, you go with the ultrasound.

Between 9 and 14 weeks, if the CRL and LMP dates are off by more than 7 days, you go with the ultrasound.

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152
Q

Which of the following is an accurate statement regarding serum beta hCG?

A) It can be detected 6-7 days after conception.
B) It peaks at 12-13 weeks gestation.
C) It is best to use one sentinel measure.
D) It is used when pregnancy viability is in question.

A

D) It is used when pregnancy viability is in question.

Beta hCG is used to determine fetal viability and to determine normal fetal development. It is detectable 8-11 days after conception and doubles every 2 days until it peaks at 8.5- 10 weeks gestation then rapidly declines between 12 and 16 weeks gestation. When using beta hCG measurements, it is most useful to compare two measurements taken two days apart to ascertain whether the value has doubled, thus indicating normal development.

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153
Q

The best way to initially measure uterine size in a pregnant woman presenting for care 10 weeks after her LNMP is:

A) vaginal ultrasound
B) bimanual exam
C) waiting another 2-4 weeks
D) fundal height measurement

A

B) bimanual exam

Bimanual exam is used to determine uterine size in the office between 6 and 11 weeks. After this, the uterus becomes an abdominal organ and finger breadths above the symphysis would be used. Once the woman reaches 20 weeks, uterine size is measured by fundal height measurement (Let’s talk).

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154
Q

Which statement contains appropriate information to tell women about ultrasound dating?

A) An ultrasound for dating pregnancy is best done between 7-10 and 16-18 weeks gestation, and has been documented as safe for mother and baby.
B) An ultrasound for dating pregnancy is best done between 8 and 11 weeks gestation and does not cause maternal harm.
C) Ultrasound use can cause potential heating of fetal cells and is most accurate for dating if done between 16 and 22 weeks gestation.
D) Ultrasound for dating pregnancy is best done between 7-9 weeks gestation and is theoretically linked to right-handedness with multiple exposures.

A

A) An ultrasound for dating pregnancy is best done between 7-10 and 16-18 weeks gestation, and has been documented as safe for mother and baby.

Ultrasound dating is best done in the first trimester between 7 and 10 weeks. When this is not possible, the ultrasound should be done between 16 and 18 weeks because this allows for dating the pregnancy as well as doing an anatomic survey as long as the woman agrees to this form of genetic screening.Informed consent is ethically required here. Studies on USN safety have been done on a limited number of USN’s (1-2),not multiple USN’s. So we can say that a dating ultrasound has been shown to be safe for mother and fetus.

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155
Q

Which of the following is detectable in maternal serum and urine 8-10 days after fertilization?

A) Human chorionic gonadotropin
B) Oxytocin
C) Human placental lactogen
D) Prolactin

A

A) Human chorionic gonadotropin

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156
Q

Prior to seeing a woman in clinic, the provider notes that her sure LNMP was May 3, 2017. It is now February 1, 2018. How many weeks pregnant is she?

A

38 weeks 5 days

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157
Q

A pregnant woman has an ultrasound for dating at 19 weeks gestation. It is most appropriate to advise her that:

A) her EDB is accurate to within plus or minus 5 days
B) her EDB is accurate to within plus or minus 20 days
C) she will need a follow-up ultrasound for comparison in the early third trimester
D) her EDB is accurate to within plus or minus 10 days

A

D) her EDB is accurate to within plus or minus 10 days

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158
Q

When using vaginal ultrasound to date pregnancy, the criterion measurement is:

A

crown-rump length

Crown rump length (CRL) is the most accurate predictor of gestational age in the first trimester when a vaginal probe ultrasound would be done.

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159
Q

Two of the criterion measurements used in ultrasound dating of pregnancy in the second trimester are:

A

biparietal diameter and femur length

Combining measurements of head circumference, biparietal diameter, abdominal circumference and femur length provide an estimation of gestational age by ultrasound in the second trimester.

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160
Q

A woman reports her last normal menstrual period as “about 4 months ago.” Her uterus is approximately 10 week size. Which is the most appropriate next step in dating her pregnancy?

A) advise an abdominal ultrasound
B) obtain a beta hCG level
C) inquire about presence of cramping and/or bleeding
D) advise a vaginal ultrasound

A

D) advise a vaginal ultrasound

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161
Q

At her first prenatal visit, a woman reports that her last menstrual period was May 21. Her periods are consistently every 28 days and last 5 days. Naegele’s rule indicates which due date?

A

February 28

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162
Q

A woman is in clinic today for her first prenatal visit. She tells the midwife/WHNP the date of her LMP which was 11 weeks ago. Her uterus is palpable 3 finger breadths above the symphasis. The best way to date her pregnancy is:

A) beta hCG and onset of presumptive signs
B) vaginal ultrasound
C) abdominal ultrasound
D) Naegle’s rule

A

C) abdominal ultrasound

Correct! Because of the discrepancy between the location of the fundus and the time elapsed since the reported LMP, an ultrasound for dating the pregnancy is indicated. The location of her fundus indicates she is likely in the second trimester; therefore an abdominal ultrasound would be indicated to date her pregnancy.

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163
Q

A 24 year old G3P1011 is here for her regular prenatal visit at 26 weeks gestation. Her prenatal course has been uncomplicated. Her uterus measures 28 centimeters by tape measure. It is most appropriate for the CNM/WHNP to:

A) tell her that her uterus is growing normally
B) advise an ultrasound for size/dates discrepancy
C) determine if the fetus is breech
D) inquire about recent changes in her diet and her weight gain

A

A) tell her that her uterus is growing normally

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164
Q

A woman’s last normal menstrual period was on July 16th. By that LMP, her EDB is April 23rd.
An ultrasound done on October 10th, when she would be 12 weeks pregnant by her LMP, showed her to be 10 weeks, 3 days pregnant with an EDB of May 6th.
According to ACOG Guidelines, what is her EDB?

A

May 6th

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165
Q

A woman reports her last normal menstrual period as “about 4 months ago.” Her uterus is approximately 10 week size. Which is the most appropriate next step in dating her pregnancy?

A) inquire about presence of cramping and/or bleeding
B) advise an abdominal ultrasound
C) obtain a beta hCG level
D) advise a vaginal ultrasound

A

D) advise a vaginal ultrasound

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166
Q

Which of the following is a positive sign of pregnancy?

A) nausea and vomiting
B) visualizing the fetus on ultrasound
C) positive pregnancy test
D) maternal sensation of fetal movement

A

B) visualizing the fetus on ultrasound

Presumptive: pregnancy discomforts, amenorrhea

Probable: + pregnancy test, Chadwick’s sign

Positive: FHTs, ultrasound

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167
Q

A woman presents to the office today for her first prenatal visit. Her LMP was 10 weeks ago, and was normal. She reports breast tenderness and fatigue. On bimanual exam, her uterus is enlarged and is palpable below the symphysis pubis. A urine pregnancy test done today in the clinic was positive, and the midwife/WHNP and woman hear fetal heart tones with a doppler. A probable sign of pregnancy she presents with is:

A) positive pregnancy test
B) audible FHT’s by doppler
C) fatigue
D) breast tenderness

A

A) positive pregnancy test

A positive pregnancy test is a probable sign of pregnancy, while breast tenderness and fatigue are presumptive signs, and audible FHTs are a positive sign.

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168
Q

Palpating an enlarged uterus is:

A) useful in conjunction with Goodells sign
B) a probable sign of pregnancy
C) a positive sign of pregnancy
D) a presumptive sign of pregnancy

A

B) a probable sign of pregnancy

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169
Q

A presumptive sign of pregnancy is:

A) Positive B-Hcg
B) Maternal fatigue
C) Uterine enlargement
D) Palpating the fetal outline

A

B) Maternal fatigue

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170
Q

Which of the following is a positive sign of pregnancy?

A) Uterine enlargement
B) Palpation of the fetus
C) Report of quickening
D) Auscultation of fetal heart tones

A

D) Auscultation of fetal heart tones

Presumptive: pregnancy discomforts, amenorrhea

Probable: + pregnancy test, Chadwick’s sign

Positive: FHTs, ultrasound

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171
Q

A 28 year old presents to clinic for her 3rd prenatal visit at 16 weeks gestation. Appropriate anticipatory guidance includes advising her that fetal:

A) eyes are opening
B) hair growth has started
C) skeleton is rapidly growing
D) weight is 0.5-1 lbs

A

C) skeleton is rapidly growing

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172
Q

A woman presents for care with an unknown LMP. Her fundus is located midway between her symphysis and umbilicus. The midwife/WHNP knows she is most likely how many weeks gestation?

A) 20 weeks
B) it would depend on how many centimeters she measures
C) 12 weeks
D) 16 weeks

A

D) 16 weeks

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173
Q

At 36 weeks gestation, a woman’s fundal height is 32.5 cm. What should the midwife do first?

A) Schedule a return visit for 1 week later.
B) Order an abdominal ultrasound.
C) Consider alteration of her dates.
D) Consult with a physician.

A

B) Order an abdominal ultrasound.

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174
Q

Fundal height measurements:

A) measure from the bladder to the fundus.
B) are most accurate when performed by the same examiner.
C) are an accurate indication of fetal weight.
D) are less accurate for monitoring fetal growth than serial ultrasounds.

A

B) are most accurate when performed by the same examiner.

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175
Q

When evaluating a fetus for macrosomia during the third trimester the midwife is aware that a(n)

A) clinician’s estimated fetal weight (EFW) via Leopold’s is inaccurate compared to an ultrasound’s (US) estimated fetal weight (EFW).
B) multiparous women’s prediction of fetal weight is inaccurate compared to an ultrasound’s (US) estimated fetal weight (EFW).
C) ultrasound (US) estimated fetal weight (EFW) has a positive predictive value (PPV) of 97-99%.
D) ultrasound (US) may have an error of ± 15% or ± 1 pound in a 7 lb infant.

A

D) ultrasound (US) may have an error of ± 15% or ± 1 pound in a 7 lb infant.

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176
Q

A 29-year-old G3P1011 now at 36 weeks gestation is here for her routine visit. In her chart the midwife notes her BMI is 25.3, ultrasound at 10 weeks gestation confirms dates and fundal height at 34 weeks was 36 cms. Today her fundal height is 40 cms and by Leopold’s the fetal lie is oblique. Which of the following is most important to review from her chart?

A) Weight gain pattern
B) Diet interventions
C) 28 week glucose screen
D) Estimated fetal weight on 20 week ultrasound

A

C) 28 week glucose screen

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177
Q

When evaluating a fetus for macrosomia during the third trimester the midwife is aware that a(n)

A) ultrasound (US) estimated fetal weight (EFW) has a positive predictive value (PPV) of 97-99%.
B) multiparous women’s prediction of fetal weight is inaccurate compared to an ultrasound’s (US) estimated fetal weight (EFW).
C) ultrasound (US) may have an error of ± 15% or ± 1 pound in a 7 lb infant.
D) clinician’s estimated fetal weight (EFW) via Leopold’s is inaccurate compared to an ultrasound’s (US) estimated fetal weight (EFW).

A

C) ultrasound (US) may have an error of ± 15% or ± 1 pound in a 7 lb infant.

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178
Q

A woman is 14 weeks gestation and presents for her 2nd visit. Her uterine size is best measured by:

A) tape measure
B) Leopolds maneuvers
C) vaginal exam
D) Fingerbreadth palpation

A

D) Fingerbreadth palpation

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179
Q

A woman presents for a routine prenatal appointment at 39 weeks gestation. Her fundal height measures 37 cm. At 38 weeks, the fundal height was 38 cm. FHTs by Doppler are 145. Appropriate management would include which of the following:

A) Consulting with the CNM/WHNP’s consultant physician
B) Recommending an induction of labor
C) Offering her an ultrasound to check fetal growth
D) Reassuring her of normalcy and scheduling her next visit in one week

A

D) Reassuring her of normalcy and scheduling her next visit in one week

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180
Q

The CNM/WHNP desires to estimate the fetal weight. Which of the following is true regarding estimating fetal weight (EFW):

A) An ultrasound is the most accurate way to determine EFW
B) Measuring fundal height is an accurate way to estimate fetal weight
C) Leopold’s maneuvers are more accurate than ultrasound to determine EFW
D) There is no precise tool to accurately determine fetal weight

A

D) There is no precise tool to accurately determine fetal weight

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181
Q

Which condition may cause asymmetric fetal growth restriction in a newborn?

A) Cytomegalovirus (CMV) infection
B) Preeclampsia
C) Severe chronic maternal malnutrition
D) Chromosomal disorders

A

B) Preeclampsia

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182
Q

A 36-year-old G2P1001 at 33 weeks gestation presents for her routine prenatal visit. A chart review reveals: smoker- 1ppd, history of cocaine use (prior to pregnancy); Body mass index (BMI) 24.3; a total weight gain of 22 pounds; fundal height at 30 weeks was 28 cms. Fundal height today is 29 cms and the woman reports good fetal movement. APRN management should include

A) encouraging weight gain and smoking cessation, performing random drug screening, and referring to a nutritionist.
B) assessing readiness for smoking cessation, performing drug screening and starting biweekly non-stress tests (NST).
C) ordering an ultrasound and assessing substance use and readiness for smoking cessation.
D) repeating fundal height and starting non-stress test at 36 weeks gestation because she is a smoker.

A

C) ordering an ultrasound and assessing substance use and readiness for smoking cessation.

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183
Q

A 24 year old G3P1011 is here for her regular prenatal visit at 26 weeks gestation. Her prenatal course has been uncomplicated. Her uterus measures 28 cms by tape measure. It is most appropriate for the CNM/WHNP to:

A) inquire about recent changes in her diet and her weight gain
B) determine if the fetus is breech
C) advise an ultrasound for size/dates discrepancy
D) tell her that her uterus is growing normally

A

D) tell her that her uterus is growing normally

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184
Q

A woman at 28 weeks gestation presents for a routine prenatal visit. The midwife/WHNP expects her fundal height to be:

A

between 26 and 30 centimeters

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185
Q

Rho-gam (a gamma globulin) given to a pregnant woman whose red blood cells are Rh negative will give her

A) acquired immunity against negative Rh red blood cells from the fetus.
B) passive immunity against negative Rh red blood cells from the fetus.
C) acquired immunity against positive Rh red blood cells from the fetus.
D) passive immunity against positive Rh red blood cells from the fetus.

A

D) passive immunity against positive Rh red blood cells from the fetus.

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186
Q

What is the appropriate time in pregnancy to draw an antibody screen for all women?

A

at the first prenatal visit

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187
Q

A 24 year old G2 P1001 with Rh negative blood is 8 weeks pregnant and is experiencing vaginal bleeding. She presents to clinic for an evaluation. Which plan of action is most appropriate?

A) inform the woman that because she is so early in her pregnancy she will not need to receive Rhogam at this time
B) order an abdominal ultrasound and administer 300 mcg of Rhogam
C) administer 50 mcg of Rhogam and schedule her for a follow up appointment at 12 weeks gestation
D) order a vaginal probe ultrasound and administer 50 mcg of Rhogam

A

D) order a vaginal probe ultrasound and administer 50 mcg of Rhogam

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188
Q

Why is RhoGAM given to women who are Rh negative?

A) To protect the fetus from neural tube defects.
B) To decrease the risk of miscarriage.
C) To prevent antigen-antibody reactions to any fetal blood cells that may enter the woman’s blood.
D) To prevent the woman from developing anemia in future pregnancies.

A

C) To prevent antigen-antibody reactions to any fetal blood cells that may enter the woman’s blood.

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189
Q

A 28 year old G4P3003 at 22 weeks gestation with blood type B negative asks the CNM/WHNP when she will receive her Rhogam injection. She is not planning on having more children. Which of the following responses is most appropriate?

A) “Since you are not planning on having more children, you won’t need a Rhogam shot this pregnancy.”
B) “You’ll have an antibody screen drawn at your next visit. Then, if the results are negative, you will need to return to clinic to receive your Rhogam.”
C) “You’ll have an antibody screen drawn and receive your Rhogam dose at your 28 week visit.”
D) “You’ll receive a dose of Rhogam at your next visit and then again if you remain pregnant beyond 40 weeks.”

A

C) “You’ll have an antibody screen drawn and receive your Rhogam dose at your 28 week visit.”

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190
Q

SATA: In what forms can you order Rh D Immune Globulin?

A) IV
B) SQ
C) PO
D) IM

A

A) IV
D) IM

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191
Q

When the mother’s immune system becomes sensitized against antigens expressed by the fetus, what type of immune reaction is occurring?

A) Autoimmune type 1 hypersensitivity
B) Allergic, type II hypersensitivity
C) Immune complex, type II hypersensitivity
D) Alloimmune, type II hypersensitivity

A

D) Alloimmune, type II hypersensitivity

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192
Q

T/F: Administration of Rhogam at 28 weeks should occur even if the antibody screen is not known to be negative at the time of Rhogam administration.

A

True

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193
Q

How many milliliters of maternal-fetal hemorrhage does a routine dose of Rhogam cover?

A

15ml

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194
Q

At which point in pregnancy is an Rh negative woman most likely to become Rh alloimmunized?

A) during a first trimester miscarriage
B) during a genetic amniocentesis
C) during an abortion
D) at birth

A

D) at birth

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195
Q

The lab test that measures the average size of red blood cells is:

A) hemoglobin
B) hematocrit
C) MCHC (mean corpuscular hemoglobin concentration)
D) MCV (mean corpuscular volume)

A

D) MCV (mean corpuscular volume)

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196
Q

T/F: During review of AP labs, the CNM notes positive IgG anti-HCV. Hepatitis C can be confirmed with a positive IgG anti-HCV.

A

True

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197
Q

T/F: A Hemoglobin and Hematocrit (H&H) may be ordered in place of a Complete Blood Count (CBC) when routine labs are drawn at the first prenatal visit.

A

False

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198
Q

When should women who are at high risk for chlamydia and gonorrhea be screened?

A

At the first prenatal visit and in the third trimester

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199
Q

The lab test that is highly specific in its correlation with total iron stores and is considered the gold standard for the diagnosis of iron deficiency anemia is:

A

Serum ferritin

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200
Q

Appropriate labs to obtain for all women at the first prenatal visit are:

A) blood type, antibody screen, and HIV test
B) chlamydia and gonorrhea screening and bacterial vaginitis (BV) screening by wet-prep
C) Pap smear and urine culture
D) one hour glucose tolerance test and quad screen

A

A) blood type, antibody screen, and HIV test

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201
Q

Normal pregnancy hemoglobin and hematocrit levels are

A) hemoglobin 11 g and hematocrit 33% during the first and third trimester.
B) hemoglobin 10 g and hematocrit 31% during the second trimester.
C) adjusted for the African American woman by -0.6 g and -2.0%
D) hemoglobin 9.9 g and hematocrit 30% during the second trimester in African American women.

A

A) hemoglobin 11 g and hematocrit 33% during the first and third trimester.

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202
Q

A 26 year old at 9 weeks gestation has the following lab values. Hgb = 10.5 and Hct = 31%. It would be appropriate to

A) advise that this is normal due to increasing blood volume
B) advise to eat more nuts and raisins and retest in 4 weeks
C) encourage dietary iron sources and daily iron supplementation
D) advise Feso4 500 mg BID to be taken after meals
E) draw a serum ferritin and Hgb electrophoresis

A

E) draw a serum ferritin and Hgb electrophoresis

We can’t just offer people iron. We don’t know if this is IDA or a thalassemia. Needs further work up.

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203
Q

The practitioner knows that a “shift to the left” on a differential smear indicates:

A) a pathologic finding in pregnancy
B) an increase in immature white blood cells (WBCs)
C) an increase in mature white blood cells (WBCs)
D) impending anemia

A

B) an increase in immature white blood cells (WBCs)

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204
Q

The APRN is reviewing a pregnant patient’s prenatal labs obtained at the first prenatal visit. The hepatitis panel showed a positive HBsAg and a positive IgM anti-HBc. This indicates

A) acute Hepatitis B infection.
B) chronic Hepatitis B infection.
C) acute Hepatitis C infection.
D) immunity to Hepatitis B.

A

A) acute Hepatitis B infection.

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205
Q

T/F: All women should be screened for trichomonas and bacterial vaginitis at the first prenatal visit.

A

False

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206
Q

A reactive RPR result with a titer of 1:16 most likely indicates:

A) active syphilis
B) a history of syphilis
C) the absence of syphilis
D) concurrent HIV infection

A

A) active syphilis

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207
Q

Prenatal lab results are hemoglobin 10; hematocrit 30; MCV 77; MCH 26; platelets 152,000. These values indicate:

A) iron deficiency anemia
B) macrocytic anemia
C) pernicious anemia
D) thalassemia

A

A) iron deficiency anemia

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208
Q

Normal pregnancy hemoglobin and hematocrit levels are

A) hemoglobin 11 g and hematocrit 33% during the first and third trimester.
B) hemoglobin 10 g and hematocrit 31% during the second trimester.
C) adjusted for the African American woman by -0.6 g and -2.0%
D) hemoglobin 9.9 g and hematocrit 30% during the second trimester in African American women.

A

A) hemoglobin 11 g and hematocrit 33% during the first and third trimester.

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209
Q

Hemoglobin Electrophoresis is useful in identifying which of the following conditions?

A) hemoglobinopathies
B) iron deficiency anemia
C) the presence of infection
D) pernicious anemia

A

A) hemoglobinopathies

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210
Q

Laboratory testing for HIV commonly includes which of the following test(s):

A) ELISA followed by Western Blot
B) DNA sequencing
C) Western Blot
D) ELISA

A

A) ELISA followed by Western Blot

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211
Q

The CNM/WHNP is discussing OB lab results with a pregnant woman at her second prenatal visit. The results of the labs are as follows: Urine culture: E. Coli >100,000 colonies; H&H 11.2/33.5; RPR: nonreactive; Rubella titer: 1:12; Platelets: 205,000, HBsAg: nonreactive, HIV: negative. Which of the following information is most appropriate to give this woman?

A) Her prenatal labs are normal.
B) She should start taking iron supplements.
C) She needs a prescription for antibiotics.
D) Avoid contact with ill children.

A

C) She needs a prescription for antibiotics.

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212
Q

At 8 weeks gestation, hCG levels should ______ approximately every 48 hours.

A

Double

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213
Q

T/F: All women should be screened for Hepatitis C in pregnancy.

A

True

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214
Q

When is a routine prenatal urine culture most appropriately ordered?

A) At the first OB visit.
B) At any time during pregnancy.
C) At 28 weeks gestation.
D) At 36 weeks gestation.

A

A) At the first OB visit.

Varney 6e P. 706 and 707. Untreated bacteriuria increases the risk a woman will develop pyelonephritis; Treatment of bacteriuria is per standard guidelines.

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215
Q

A 27-year-old woman at 12 weeks gestation is diagnosed with alpha thalassemia. Review of her labs reveal
RBC 5.8 (high)
RDW% (Red Cell Distribution Width) 11.5% (normal)
Hemoglobin 11.0 g/dL
Hematocrit 33.0%
MCV (Mean Corpuscular volume) 73 fL (low)
MCH (Mean Corpuscular hemoglobin) 22 pg (low)
Ferritin 50 mg/dL (normal)
Reticulcyte count normal
The most appropriate management plan includes

A) increased folate supplementation.
B) iron supplementation.
C) prenatal vitamin supplementation.
D) vitamin B12 supplementation.

A

C) prenatal vitamin supplementation.

This client doesn’t need anything but a PNV. Look at the H/H. It is normal. Varney p. 179: When the diagnosis of thalassemia is established, folic acid supplementation may be employed but iron therapy is inappropriate. From Up To Date 2021- The possibility of folate deficiency may be evaluated in individuals not receiving folic acid Links to an external site. who develop worsening of anemia, especially if associated with an increase in mean corpuscular volume (MCV) and a decrease in reticulocyte count.)

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216
Q

A woman’s initial prenatal lab results are: hemoglobin 9.8; blood type O positive; antibody screen negative; 10,000 colony forming units of Escherichia coli on urine culture; hemoglobin A1c 5.0. A concern in this case is:

A) anemia
B) diabetes
C) hemolytic disease
D) urinary tract infection

A

A) anemia

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217
Q

A woman presenting for her first prenatal visit reports a history of treatment for primary syphilis 10 years prior to this pregnancy. The CNM/WHNP expects the VDRL/RPR titer to be:

A) normal
B) increased
C) decreased
D) equivocal

A

A) normal

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218
Q

An African woman presents for prenatal care. The CNM/WHNP knows that the most appropriate sickle cell anemia screening test to order for this woman is:

A) Sickledex and Hemoglobin & Hematocrit (H&H)
B) Hemoglobin Electrophoresis and Complete Blood Count (CBC)
C) Complete Metabolic Panel (CMP) and Hemoglobin SC
D) Either a hemoglobin/hematocrit (H&H) or Complete Blood Count (CBC)

A

B) Hemoglobin Electrophoresis and Complete Blood Count (CBC)

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219
Q

Which of the following women should NOT be routinely screened for GBS at 35 to 37 weeks of pregnancy?

A) A woman who had any amount of GBS on her initial urine culture.
B) A woman who screened positive for GBS in her last pregnancy.
C) A woman who had a negative vaginal swab for GBS when she was having preterm contractions at 28 weeks gestation.
D) A woman who is allergic to Penicillin.

A

A) A woman who had any amount of GBS on her initial urine culture.

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220
Q

Which of the following is the lab test used for the routine prenatal antibody screen?

A) Indirect Coombs
B) Direct Coombs
C) Kleihauer Betke
D) Rosette test

A

A) Indirect Coombs

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221
Q

A CBC is routinely obtained at what point(s) in pregnancy?

A) The first prenatal visit
B) With any sign or symptom of anemia
C) The first prenatal visit and at 28 weeks
D) At 18 and 36 weeks

A

C) The first prenatal visit and at 28 weeks

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222
Q

A “shift to the left” indicates:

A) the presence of more mature WBCs
B) the presence of more immature WBCs
C) infection
D) leukemia

A

B) the presence of more immature WBCs

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223
Q

Which of the following CBC results would the CNM/WHNP be most likely to see in cases of iron deficiency anemia?

A) Increased MCHC, Decreased MCV, Decreased MCH
B) Decreased MCHC, Decreased MCV, Increased MCH
C) Increased MCHC, Increased MCV, Increased MCH
D) Decreased MCHC, Decreased MCV, Decreased MCH

A

D) Decreased MCHC, Decreased MCV, Decreased MCH

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224
Q

Women are most likely to be found to be anemic in the late second/early third trimester because:

A) this is the point of maximum maternal hemodilution
B) their bodies are not able to keep up with the baby’s need to create blood cells
C) fetal use of iron stores increases at this time
D) plasma expansion is beginning at this time

A

A) this is the point of maximum maternal hemodilution

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225
Q

The term “physiologic anemia” describes which of the following:

A) the greater rise in plasma volume as compared to red blood cells
B) iron deficiency anemia in pregnancy
C) the physiologic increase of plasma and RBCs during early pregnancy
D) the normal decrease in WBCs during pregnancy

A

A) the greater rise in plasma volume as compared to red blood cells

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226
Q

Which of the following anemias is most frequently diagnosed during pregnancy?

A) Iron Deficiency Anemia
B) Sickle Cell Anemia
C) Pernicious Anemia
D) Vitamin Deficiency Anemia

A

A) Iron Deficiency Anemia

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227
Q

All people should be offered which of the following tests in pregnancy to screen for hemoglobinopathy:

A) CBC
B) Hemoglobin electrophoresis
C) Sickledex
D) CBC and hemoglobin electrophoresis

A

D) CBC and hemoglobin electrophoresis

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228
Q

Which of the following women is more likely to transmit Hepatitis B to her fetus?

A) A woman who screens HBsAg positive and HBeAg negative
B) A woman who screens HBsAg positive and HBeAg positive
C) A woman who screened HCsAg positive
D) A woman who is known to have chronic hepatitis B prior to pregnancy

A

B) A woman who screens HBsAg positive and HBeAg positive

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229
Q

Which of the following is a true statement about serum pregnancy testing?

A) the detection of leutenizing hormone improves reliability
B) results are dependent upon beta hCG
C) false positives are very common
D) testing is best done between 9 and 12 weeks gestation

A

B) results are dependent upon beta hCG

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230
Q

A 24 year old G3P1011 presents to clinic for her regular prenatal visit at 28 weeks gestation. Her prenatal course has been uncomplicated. She is Rh negative. Appropriate labs to obtain at this visit are:

A) antibody screen and hemoglobin & hematocrit (H&H)
B) gonorrhea and chlamydia culture and HBeAG
C) urine culture and RPR
D) urinalysis and repeat HIV screening

A

A) antibody screen and hemoglobin & hematocrit (H&H)

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231
Q

A woman at 15 weeks gestation stepped on a rusty nail that punctured the skin. Her last tetanus injection was over 10 years ago. It is most appropriate to tell her that:

A) tetanus immunoglobulin should be given rather than a booster
B) she will be referred to infectious disease for the next step
C) she needs serum testing before any further tetanus vaccination
D) it is safe to get a tetanus booster in pregnancy

A

D) it is safe to get a tetanus booster in pregnancy

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232
Q

Which is TRUE regarding the Tdap vaccine during pregnancy?

A) The ideal time for administration is between 27 and 36 weeks gestation, but any trimester is acceptable.
B) The ideal time for administration is between 12 and 15 weeks gestation to provide adequate coverage.
C) If the woman was vaccinated within 4-6 months before pregnancy, administration in the current pregnancy is not necessary.

A

A) The ideal time for administration is between 27 and 36 weeks gestation, but any trimester is acceptable.

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233
Q

Which of the following should pregnant women avoid?

A) Tetanus vaccine
B) Hepatitis B vaccine
C) Influenza nasal spray vaccine.
D) Hepatitis A vaccine

A

C) Influenza nasal spray vaccine.

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234
Q

Which of the following is accurate information to provide to a pregnant woman who asks about receiving the flu vaccine?

A) “You may receive either the flu vaccine or flu mist to help prevent you from getting the flu.”
B) “You should wait until after your first trimester to receive the flu vaccine.”
C) “Infants of women who receive a flu vaccine during pregnancy have less illness and infection after they are born.”
D) “Pregnant women have less risk of morbidity and mortality from the flu virus than do non-pregnant women.”

A

C) “Infants of women who receive a flu vaccine during pregnancy have less illness and infection after they are born.”

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235
Q

Mothers and children get the most benefit from stopping smoking

A) prior to 15 weeks gestation
B) in the second trimester
C) anytime during pregnancy
D) immediately prior to delivery

A

A) prior to 15 weeks gestation

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236
Q

Which of the following statements about Tdap vaccination in pregnancy is accurate?

A) Pregnant women should only receive Tdap between 27 and 32 weeks gestation
B) Women who do not receive Tdap during pregnancy should be vaccinated after delivery if they are due
C) A woman who is pregnant with her second baby in 2 years does not need Tdap as long as she received it during her first pregnancy
D) Tdap vaccination during pregnancy is safe because it is a live vaccine

A

B) Women who do not receive Tdap during pregnancy should be vaccinated after delivery if they are due

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237
Q

When counseling women preconceptually and during pregnancy it is important to encourage women to adjust their alcohol use because

A) low to moderate levels of alcohol consumption are not associated with cognitive deficits or behavioral problems.
B) alcohol use increases the risk of alcohol related birth defects, behavioral disorders, and cognitive development.
C) a 5 oz. glass of red wine contains less alcohol than 1.5 oz. of 80 proof hard liquor.

A

B) alcohol use increases the risk of alcohol related birth defects, behavioral disorders, and cognitive development.

238
Q

A woman presents for her first prenatal visit at 8 weeks gestation. Her anniversary is next week, and she asks if she can have a glass of wine when she and her husband go to dinner. Which of the following is the best advice to give her?

A) “You should only have one glass of wine because you’re pregnant.”
B) “Alcohol is only safe to drink in the late third trimester.”
C) “Pregnant women are strongly urged not to drink alcohol in pregnancy.”
D) “We don’t think that a small amount of alcohol in pregnancy is dangerous, so just this once would be fine.”

A

C) “Pregnant women are strongly urged not to drink alcohol in pregnancy.”

239
Q

A 29 year old G4P1112 comes in for her first visit at 12 weeks gestation by LNMP. She reports that she avoids brushing her teeth often because she frequently sees blood after brushing her teeth. On exam, the midwife notes that her gums are red and inflamed. It would be appropriate to advise her to:

A) stop dental brushing and flossing to further reduce any gum bleeding.
B) schedule a dental appointment.
C) avoid dental x-rays until after organogenesis is completed.
D) start taking calcium supplements to counteract pregnancy induced tooth weakening.

A

B) schedule a dental appointment.

240
Q

Primary prevention prenatal strategies for fetal growth restriction include

A) eating for two.
B) minimal exercise.
C) vitamin B6 (pyridoxine)150 mg/day.
D) tobacco cessation.

A

D) tobacco cessation.

241
Q

A woman at 24 weeks gestation informs the midwife/WHNP she has required work-related airline travel to another state for a meeting within the next month. The most appropriate response is:

A) Offer her a letter to give her employer so she may be excused from work-related travel
B) Provide her with a copy of her prenatal record and offer reassurance that travel at this time is safe
C) Advise her to drive to her destination instead of fly since travel by car is safer than travel by air at this point
D) Suggest she refrain from drinking fluids for 12 hours prior to travel

A

B) Provide her with a copy of her prenatal record and offer reassurance that travel at this time is safe

242
Q

A pregnant woman reports she is beginning to work on her baby’s nursery. She plans to paint and lay hardwood floors. She especially likes the nursery because she owns an older house and the room is in the attic and hasn’t been remodeled since the house was built. There is a beautiful bay window to look out of while rocking the baby. Which piece of advice would be most important for the CNM to share with the woman at this time?

A) “Do not strip old paint off the walls yourself because of the potential for lead exposure.”
B) “You may want to consider getting a built-in intercom system installed since you’re already remodeling the room.”
C) “Be sure to secure all of the strings on the window blinds of the bay window to prevent infant strangulation.”
D) “Be sure to put a soft rug next to the crib to stand on while holding the baby to prevent low back pain after the birth.”

A

A) “Do not strip old paint off the walls yourself because of the potential for lead exposure.”

243
Q

During which period of exposure is a teratogen likely to lead to miscarriage?

A) At any time during pregnancy
B) During fetal organogenesis
C) During the last trimester of pregnancy
D) During the first 15 days of after conception

A

D) During the first 15 days of after conception

244
Q

A woman at 6 weeks gestation presents for prenatal care and says that she has heard that exposure to some substances can cause pregnancy loss. The CNM knows that substances considered to be teratogenic:

A) Must cause abnormalities at any level of exposure (dosage level) during pregnancy
B) Do not have a dose-response effect
C) Must have a stage-sensitive effect depending on the time of exposure during pregnancy
D) Must cause a structural abnormality in the fetus

A

C) Must have a stage-sensitive effect depending on the time of exposure during pregnancy

245
Q

Which of the following tests is NOT recommended for all women at the first prenatal visit?

A) Pap smear
B) Blood type and Rh
C) Urine culture for asymptomatic bacteriuria
D) HIV screening

A

A) Pap smear

246
Q

Pregnant women who do not participate in a regular exercise program before pregnancy should be advised to:

A) Avoid organized exercise classes because they may feel pressured to exercise at too high of an intensity to keep up with the other participants
B) Closely monitor their lower extremities for red spots and hot spots because they are at increased risk of thrombophlebitis
C) Start walking for half hour a day most days of the week
D) Not participate in any exercise activities that will cause their heart rate to rise over 100 bpm.

A

C) Start walking for half hour a day most days of the week

247
Q

A woman presents for her second prenatal visit at 12 weeks gestation. Her labs include: hemoglobin- 9.8, hematocrit- 30.0, platelets – 251,000, RBC – 10.1. She states that her nausea is mostly improved although she is still a little tired. She has gained 2 pounds in the past month. It would be most important to:

A) Ask about eating non-food substances
B) Ask her what she does to treat her fatigue
C) Counsel her about appropriate weight gain
D) Advise her to contact Women, Infants and Children program (WIC)

A

A) Ask about eating non-food substances

248
Q

Women with frequent nausea and vomiting in pregnancy should be advised:

A) to rinse with water and use over-the-counter fluoride rinse after vomiting
B) to have more frequent dental cleanings
C) to avoid brushing since it exacerbates nausea and vomiting due to stimulation of the gag reflex
D) to eat carbohydrate-rich diets to help protect their teeth from decay

A

A) to rinse with water and use over-the-counter fluoride rinse after vomiting

249
Q

Which of the following are appropriate data points to collect at follow-up (subsequent) prenatal visits?

A) signs and symptoms of common pregnancy problems, lifestyle changes, and experiences of common discomforts
B) complete health history, recent illnesses, experiences of common discomforts
C) family history, experiences of common pregnancy changes and discomforts, signs and symptoms of common pregnancy problems
D) obstetrical history, common pregnancy problems, recent illnesses

A

A) signs and symptoms of common pregnancy problems, lifestyle changes, and experiences of common discomforts

250
Q

Which of the following is an accurate statement regarding exercise in pregnancy?

A) Abdominal strengthening exercises should not be done in pregnancy
B) There is increased oxygen available for exercise during pregnancy
C) Warm-up is not always needed since BMI is increased in pregnancy
D) Pregnant women may continue any non-dangerous exercise that they are accustomed to

A

D) Pregnant women may continue any non-dangerous exercise that they are accustomed to

251
Q

A pregnant woman presents at 6 weeks gestation by LMP for her first prenatal visit. She reports being a lacto-ovovegetarian. The CNM/WHNP knows that this means:

A) She does not consume any eggs, dairy, meat, fish, or poultry
B) She consumes eggs, but no dairy, meat, fish, or poultry
C) She consumes dairy, but no eggs, meat, fish or poultry
D) She consumes diary and eggs, but no meat, fish, or poultry

A

D) She consumes diary and eggs, but no meat, fish, or poultry

252
Q

Major goals of the first prenatal visit include all of the following EXCEPT:

A) Determine gestational age and EDB
B) Establish a relationship with the pregnant woman
C) Initiate a plan for continuing care throughout the pregnancy
D) Inform the woman of the tests and procedures she should expect to occur throughout the pregnancy

A

D) Inform the woman of the tests and procedures she should expect to occur throughout the pregnancy

253
Q

Dental care in pregnancy is important for all of the following reasons EXCEPT:

A) It identifies and treats dental caries
B) It decreases the risk of dental caries in the child
C) It can prevent and/or treat periodontal disease
D) It decreases the symptom of bleeding gums

A

D) It decreases the symptom of bleeding gums

254
Q

A 35 year old G1P0 is 9 weeks gestation and will be pregnant through the winter and into the spring. She should be informed:

A) that the inactive influenza vaccine is safe.
B) to avoid all immunizations until postpartum.
C) that it’s beneficial to have the pneumococcal vaccine.
D) to not have any vaccinations during the first trimester.

A

A) that the inactive influenza vaccine is safe.

255
Q

Which of the following is TRUE regarding appropriate education during pregnancy?

A) During the FIRST trimester, women should receive counseling about signs and symptoms of preterm labor.
B) Beginning in the THIRD trimester, women should be given an opportunity to learn about the philosophy of different care providers and the options for place of birth.
C) Beginning in the SECOND trimester, women should receive counseling about food safety.
D) During EACH trimester, women should receive counseling about danger signs to report to the provider.

A

D) During EACH trimester, women should receive counseling about danger signs to report to the provider.

256
Q

A woman at 10.6 weeks gestation by certain LNMP is her for her first visit. You find that her uterus is retroverted on bimanual exam. It is best to tell her that:

A) FHT’s will likely not be heard today
B) she will need physician consultation before the end of the visit
C) fetal movement will start later for her
D) ultrasound will be needed to document her pregnancy

A

A) FHT’s will likely not be heard today

257
Q

To avoid mercury exposure in pregnancy, women should be advised to:

A) Defer spraying their garden for insects until after delivery.
B) Use glass instead of plastic containers while heating food.
C) Have their private well tested for mercury.
D) Avoid eating swordfish and shark.

A

D) Avoid eating swordfish and shark.

258
Q

Which oral health anticipatory guidance for pregnant women is FALSE?

A) Use an oral fluoride rinse after vomiting
B) Cavities may be treated with fillings or crowns, as directed by a dentist
C) Avoid all dental radiology in the third trimester
D) Teeth cleaning with usual dental scaling is safe

A

C) Avoid all dental radiology in the third trimester

259
Q

Which statement is true regarding safety of planned labor after cesarean (LAC) as compared to elective repeat cesarean delivery (ERCD)?

A) Elective repeat cesarean delivery (ERCD) is safer than labor after cesarean(LAC).
B) Elective repeat cesarean delivery (ERCD) and labor after cesarean (LAC) are equally safe.
C) When deciding between elective repeat cesarean delivery (ERCD) and labor after cesarean (LAC) short term and long term risks and benefits must be considered .
D) Labor after cesarean (LAC) has less risk than elective repeat cesarean delivery (ERCD).

A

C) When deciding between elective repeat cesarean delivery (ERCD) and labor after cesarean (LAC) short term and long term risks and benefits must be considered .

260
Q

Teratogens that affect which organ can cause damage at any time during pregnancy?

A) the brain
B) the heart
C) the neural tube
D) the kidney

A

A) the brain

261
Q

Which of these statements is true regarding oral health in pregnancy?

A) Dental caries are more common during pregnancy and should be treated as soon as possible.
B) Receiving x-rays at the dentist during pregnancy is dangerous to the developing fetus, so postpartum follow up should be suggested.
C) Experiencing bleeding gums is a common occurrence in pregnancy and is related to increased hormone levels.
D) Pregnant women should avoid having dental problems treated during pregnancy since use of medication during dental procedures is contraindicated.

A

C) Experiencing bleeding gums is a common occurrence in pregnancy and is related to increased hormone levels.

262
Q

Correct advice to a pregnant woman about alcohol consumption includes

A) “Beer and wine do not have a lot of alcohol, and thus are not a problem. It’s when you drink hard alcohol that it becomes a problem.”
B) “Fetal alcohol syndrome (FAS) is curable if diagnosed early. It only occurs in approximately 1/1000 births. The odds are your baby will be just fine.”
C) “While a small amount of alcohol may not hurt your baby, the studies have not been able to show that even a tiny amount is safe for your baby.”
D) “Less than 1 drink per day in pregnancy is okay after the first trimester. Studies show that fetal alcohol syndrome (FAS) only occurs with binge drinking.”

A

C) “While a small amount of alcohol may not hurt your baby, the studies have not been able to show that even a tiny amount is safe for your baby.”

263
Q

Which of the following is a correct statement to tell women about exercising in pregnancy?

A) “If you exercise during your pregnancy, the research shows that you will have less chance of a cesarean birth.”
B) “You should avoid aerobic exercise in pregnancy and do mostly stretching exercises instead.”
C) “Exercising during pregnancy likely decreases your risks for gestational diabetes and preeclampsia.”
C) “’Hot yoga’ is a great exercise option for pregnant women because the heat helps neutralize the effects of relaxin on the muscles and you are less likely to be injured.”

A

C) “Exercising during pregnancy likely decreases your risks for gestational diabetes and preeclampsia.”

264
Q

The sympathomimetic decongestant pseudoephedrine (Sudafed) is associated with birth defects and teratogenicity. Which gestational period is of most concern?

A) 2nd & 3rd trimesters
B) 1st and 2nd trimesters
C) 1st Trimester

A

C) 1st Trimester

the 1st Trimester is when the decongestant pseudoephedrine (Sudafed) is associated with birth defects and teratogenicity.

265
Q

A pregnant woman is concerned that she doesn’t know what chemicals are found in the cleaning solutions she uses at work. The CNM/WHNP should recommend:

A) she ask her direct supervisor if the cleaning solutions are safe.
B) she contact the engineering department to ask them.
C) she consult the Material Safety Data Sheets (MSDS) at her workplace.
D) she make an appointment to consult the occupational health nurse.

A

C) she consult the Material Safety Data Sheets (MSDS) at her workplace.

266
Q

During routine antenatal screening for substance use, a G1P0 tearfully admits to using heroin and requests assistance in managing her addiction. The nurse-midwife explains that the goal of treatment is

A) maintanence.
B) detoxication.
C) discontinuation by tapering.

A

A) maintanence.

267
Q

Which of the following is one reason why prenatal tobacco cessation programs may be especially effective?

A) Pregnant women are highly motivated to change behaviors linked to poorer outcomes for their infants.
B) Women who quit smoking during pregnancy are not likely to start smoking agin after delivery.
C) Current recommendations support the use of pharmacotherapies during pregnancy to help women stop smoking.
D) Women are afraid of potential legal consequences for smoking during pregnancy.

A

A) Pregnant women are highly motivated to change behaviors linked to poorer outcomes for their infants.

268
Q

The CNM knows that adequate Omega-3 intake in pregnancy:

A) Lowers the risk of prolonged pregnancy
B) Improves fetal neural tube closure
C) Improves fetal brain and eye growth
D) Helps prevent stretch marks from forming

A

C) Improves fetal brain and eye growth

269
Q

A G1P0 at 8 weeks gestation informs the nurse-midwife that she regularly smoked marijuana before pregnancy and has continued using as a way to manage her morning sickness. Appropriate counseling includes pregnancy marijuana use

A) may be associated with preterm birth and abnormal neurodevelopment.
B) does not cross the placenta, nor is it associated with any adverse pregnancy outcomes.
C) clearly decreases morning sickness of pregnancy with regular use.
D) is clearly associated with specific congenital anomalies.

A

A) may be associated with preterm birth and abnormal neurodevelopment.

270
Q

The CNM/WHNP is counseling a pregnant woman about calcium intake in pregnancy. Which of the following is an appropriate statement for her to make?

A) “You need 1000 mg daily primarily for fetal neurological development.”
B) “I advise at least 1200 mg daily starting in the second trimester.”
C) “An additional supplementation of 600 mg should start at 20 weeks gestation.”
D) “Make sure your calcium intake is at least 1000 mg daily by 12 weeks gestation.”

A

D) “Make sure your calcium intake is at least 1000 mg daily by 12 weeks gestation.”

271
Q

It is important that women know the effect of teratogens, as major fetal cardiac structure development occurs:

A) Prior to 6 weeks gestation
B) At 8-10 week gestation
C) At 11-13 weeks gestation
D) Prior to conception

A

A) Prior to 6 weeks gestation

272
Q

Fetotoxic agents differ from teratogens in that:

A) they exert effects on growth or development in the second or third trimesters.
B) they cause a permanent change in structure, function, or growth.
C) they interfere with organogenesis and lead to defects like cardiac anomalies.
D) they do not cross the placenta and therefore don’t cause damage.

A

A) they exert effects on growth or development in the second or third trimesters.

273
Q

At the first prenatal visit, the midwife/WHNP collects the following data:

A) a complete health history
B) a targeted health history
C) a targeted physical exam
D) a review of the prenatal record

A

A) a complete health history

274
Q

Fetal development can be directly and indirectly affected by the prenatal abuse of substances. An example of a direct effect of nicotine on the fetus is

A) maternal malnutrition.
B) neurotransmitter system changes
C) hypoxia.

A

B) neurotransmitter system changes

275
Q

Women should be counseled that exercise in pregnancy might result in:

A) Increased fatigue
B) Improved self-image in pregnancy
C) Increased fetal weight
D) Higher risk for placenta previa

A

B) Improved self-image in pregnancy

276
Q

All of the following are an appropriate differential diagnosis for back pain in pregnancy EXCEPT:

A) preterm labor
B) urinary tract infection
C) pregnancy lordosis
D) pregnancy scoliosis

A

D) pregnancy scoliosis

277
Q

Round ligament pain:

A) usually starts around the 30th week of pregnancy.
B) is caused by the pressure from the broad ligaments impinging on the round ligaments.
C) often extends into the inguinal area.
D) can be relieved by stretching the front of the thigh

A

C) often extends into the inguinal area.

278
Q

Low back pain in pregnancy is exacerbated by:

A) lax abdominal muscles
B) long periods of inactivity
C) dehydration
D) increasing round ligament pain

A

A) lax abdominal muscles

279
Q

Which of the following is the most appropriate lab test to order when evaluating a pregnant woman for Restless Leg Syndrome?

A) Serum Ferritin
B) Serum Calcium
C) Vitamin D level
D) TSH

A

A) Serum Ferritin

280
Q

Which of the following statements regarding nausea and vomiting of pregnancy (NVP) is correct?

A) Pharmaceutical treatment is the best treatment option for pregnant women with NVP.
B) NVP often resolves spontaneously at 12 to 14 weeks gestation.
C) NVP can precipitate migraine headaches.
D) NVP rarely affects activities of daily living (ADL).

A

B) NVP often resolves spontaneously at 12 to 14 weeks gestation.

281
Q

Nausea and vomiting in pregnancy has been associated with which of the following fetal effects?

A) Decreased chance of miscarriage
B) Increased risk of fetal anomalies
C) Decreased birth weight
D) Renal abnormalities

A

A) Decreased chance of miscarriage

282
Q

Which of the following would be most appropriate in the treatment of carpal tunnel syndrome experienced for 2 weeks by a woman who is in her second trimester of pregnancy? Tylenol and

A) high doses of vitamin B6.
B) neutral position wrist splint.
C) oral diuretics.
D) RICE (rest, ice, compression & elevation).

A

B) neutral position wrist splint.

First line treatment includes neutral wrist splints, NSAIDs (or Tylenol in pregnancy), ice and activity modifications.

283
Q

A woman at 8 weeks gestation is nauseated all day. Which is an appropriate recommendation?

A) Anticipate improvement within 2 weeks.
B) Drink a glass of water with meals to keep hydrated.
C) Eat three. regular, scheduled meals a day.
D) Take vitamin B6 daily.

A

D) Take vitamin B6 daily.

284
Q

Which drug class is contraindicated for a pregnant woman with acid reflux?

A) Proton pump inhibitors (PPI’s) (Nexium)
B) Magnesium-based antacids (Milk of Magnesia)
C) Prostaglandin Analogs (Cytotec)

A

C) Prostaglandin Analogs (Cytotec)

285
Q

Which is considered the safest intervention for constipation during pregnancy?

A) Castor Oil
B) A stimulant laxative
C) Bulk-forming laxatives

A

C) Bulk-forming laxatives

286
Q

A woman reports feeling dizzy when standing for long periods of time. The clinician could advise all of the following relief measures EXCEPT:

A) Walk in place when you can’t avoid standing for long periods of time
B) Wear compression stockings when you expect to be standing for long periods of time
C) Decrease your fluid intake
D) Avoid aerobic exercise

A

C) Decrease your fluid intake

287
Q

All of the following are appropriate measures to advise pregnant women with 1st trimester nausea EXCEPT:

A) Take Vitamin B-12 50 mg po BID
B) Drink ginger root tea
C) Brush your teeth several hours after eating
D) Eat sour foods or candies

A

A) Take Vitamin B-12 50 mg po BID

288
Q

Which of the following is the best initial treatment recommendation for 3rd trimester lower back pain?

A) Perform abdominal exercises to strengthen the abdominal muscles
B) Physical therapy evaluation and treatment
C) Relaxing in a hot tub
D) Maintain good posture and body mechanics

A

D) Maintain good posture and body mechanics

289
Q

At her 28 week appointment, a woman tells the CNM/WHNP that her mother told her that sleeping on her back is dangerous during pregnancy. Discussion about the potential dangers associated with sleeping on her back best includes:

A) The need to increase her fluid intake to prevent hypotension.
B) Reassurance that if she experiences any negative effects from lying on her back, she is likely to naturally change position to alleviate them.
C) Discussion about slowly rising from a supine position to prevent a sudden drop in blood pressure.
D) Sharing that evidence shows she should not sleep on her back at any time during pregnancy.

A

B) Reassurance that if she experiences any negative effects from lying on her back, she is likely to naturally change position to alleviate them.

290
Q

While reviewing new OB labs for a woman who is 10 weeks pregnant, the CNM/WHNP notes the following: hemoglobin: 9.8, hematocrit: 30, platelets: 251,000, Rubella: Immune, RPR: nonreactive, HBsAG negative, Chlamydia and Gonorrhea: negative, Urine culture: 10,000 colonies of mixed flora, one hour glucola: 115. The most appropriate advice to give the woman is to:

A) begin taking antibiotics
B) start taking an iron supplement
C) refrain from sexual intercourse
D) decrease her sugar intake

A

B) start taking an iron supplement

291
Q

The most appropriate treatment for heartburn in pregnancy is:

A) Taking bicarbonate of soda as needed.
B) Taking an antacid with magnesium hydroxide as needed.
C) Drinking cold beverages with meals.
D) Lying on the side instead of the back after meals.

A

B) Taking an antacid with magnesium hydroxide as needed.

292
Q

A woman experiencing shortness of breath in conjunction with which of the following symptoms would need additional evaluation:

A) Nausea and vomiting
B) Respiratory rate of greater than 20
C) Increased urination
D) Heartburn

A

B) Respiratory rate of greater than 20

293
Q

The change in curvature of the lower spine during pregnancy in response to the shifting center of gravity due to the enlarging uterus is called:

A) lordosis
B) kyphosis
C) “pregnancy waddle”
D) sacroiliac joint laxity

A

A) lordosis

294
Q

The midwife evaluates a woman at 16 weeks gestation at a routine prenatal visit. The woman’s pre-pregnant weight was 192 (BMI 28). Today she weighs 191, her BP is 142/88, and the urine dip has trace protein, fundal height is halfway between the symphysis pubis and umbilicus, and the fetal heart rate is 167. The woman reports feeling anxious and moody. What should the midwife be most concerned about today?

A) anxiety and depression
B) chronic hypertension
C) fetal tachycardia
D) fetal growth restriction

A

B) chronic hypertension

295
Q

Leg cramps in pregnancy:

A) are the most common cause of Restless Leg Syndrome (RLS).
B) usually occur in both calves during sleep.
C) are sometimes relieved by taking a magnesium supplement at bedtime.
D) may be successfully treated with Quinine.

A

C) are sometimes relieved by taking a magnesium supplement at bedtime.

296
Q

What is the best first step in the plan of care for a woman at 8 weeks gestation who is experiencing daily nausea with once-daily vomiting?

A) Obtain a metabolic panel to identify an electrolyte imbalance
B) Suggest lifestyle and dietary changes
C) Suggest Vitamin B6 25 mg TID with ½ Unisom tablet at bedtime
D) Prescribe Zofran 4 mg orally every 4 hours as needed

A

B) Suggest lifestyle and dietary changes

297
Q

Which of the following hormones are the most likely cause of ligament relaxation leading to lower abdominal pain in late pregnancy?

A) progesterone and relaxin
B) estrogen and prostaglandin
C) human chorionic gonadotropin
D) human growth hormone

A

A) progesterone and relaxin

298
Q

When are symptoms of dyspnea experienced during pregnancy?

A) During the first and second trimesters
B) During the first and third trimesters
C) During the second and third trimesters
D) Throughout pregnancy

A

D) Throughout pregnancy

Varney talks about respiratory Changes on page 652 and on p. 759 saying “may appear at any time in pregnancy.”

Kelsey doesn’t specify a “most common” time.

So I consulted Williams Obstetrics. (one of the sources for the AMCB exam). It talks about pulmonary function in way more detail than Varney…and says, “Dyspnea is common.”

So the jury is out on When it is the most common. It does make sense that as the pregnancy progresses, the sensation of dyspnea may feel worse to the individual due to the enlarging uterus, the increased tidal volume, and the increased resting minute ventilation.

299
Q

Which of the following is the best advice to give women in the first trimester who report difficulty staying awake and wanting to “sleep all the time”?

A) Begin taking iron supplements
B) Begin a light intensity daily exercise program
C) Be sure to allow at least 12 hours a night for sleep
D) Increase her protein intake to 140 grams daily

A

B) Begin a light intensity daily exercise program

300
Q

A woman who is 12 weeks pregnant reports feeling short of breath even when she’s not exercising. Which of the following statements best describes the physiology underlying this symptom?

A) This sensation is secondary to awareness of hyperventilation and decreased CO2.
B) Dyspnea is secondary to the increased levels of CO2 in her lungs.
C) Pressure of the uterus on the diaphragm prevents full expansion of the lungs.
D) The decrease in HCG causes a sensation of not being able to take a full breath.

A

A) This sensation is secondary to awareness of hyperventilation and decreased CO2.

301
Q

A woman arrives to her prenatal visit reporting very swollen feet and having difficulty wearing her usual shoes. She works 8 hours a day in an office sitting at a computer. Which of the following items is most appropriate to include in her plan of care?

A) Begin a swimming program of at least 20 minutes a day
B) Order lab tests to rule out pre-eclampsia
C) Instruct her to decrease her activity
D) Instruct her to decrease her fluid intake

A

A) Begin a swimming program of at least 20 minutes a day

302
Q

Which of the following questions is most appropriate to ask a woman who reports feeling a “creepy crawling” sensation in her legs that wakes her up every night around midnight and is bothersome until it improves mid-morning?

A) “Do you have the urge to move because of the unpleasant sensations you experience in your legs?”
B) “Does rest intensify or aggravate the sensations?”
C) “When you get up and move, do the sensations seem to get better or go away?”
D) All of these are appropriate.

A

D) All of these are appropriate.

303
Q

Appropriate advice for relieving leg cramps includes:

A) applying heat and massage
B) plantar flexion and increased dietary phosphorus
C) calcium supplements and resting the affected leg
D) dorsiflexion of the foot and stretching the calf muscle

A

D) dorsiflexion of the foot and stretching the calf muscle

304
Q

Leg cramps in pregnancy:

A) are the most common cause of Restless Leg Syndrome (RLS).
B) usually occur in both calves during sleep.
C) are sometimes relieved by taking a magnesium supplement at bedtime.
D) may be successfully treated with Quinine.

A

C) are sometimes relieved by taking a magnesium supplement at bedtime.

305
Q

Which advice is best for heartburn during pregnancy?

A) Avoid beverages with meals.
B) Eat small quantities of fruit several times per day.
C) Eat foods with whole grains.
D) Lie down to rest after meals.

A

A) Avoid beverages with meals.

306
Q

Which of the following would be most appropriate in the treatment of carpal tunnel syndrome experienced for 2 weeks by a woman who is in her second trimester of pregnancy? Tylenol and

A) high doses of vitamin B6.
B) neutral position wrist splint.
C) oral diuretics.
D) RICE (rest, ice, compression & elevation).

A

B) neutral position wrist splint.

p.923 First line treatment includes neutral wrist splints, NSAIDs (or Tylenol in pregnancy), ice and activity modifications.

307
Q

Which of the following statements about low back pain (LBP) in pregnancy is correct?

A) LBP is usually related to urinary tract infections or pyelonephritis.
B) LBP often presents by 12 to 14 weeks of pregnancy.
C) LBP is caused by the effect of estrogen on skeletal muscle
D) LBP increases in severity with parity.

A

D) LBP increases in severity with parity.

308
Q

Which of the following is a true statement regarding ectopic pregnancy?

A) Pelvic inflammatory disease is a risk factor for an ectopic pregnancy
B) The incidence of ectopic pregnancy has remained stable over many decades
C) There is a risk of a persistent ectopic after treatment
D) Ectopic is most often detected between 9 and 11 weeks gestation

A

A) Pelvic inflammatory disease is a risk factor for an ectopic pregnancy

309
Q

A 33-year-old G1P0 at 9 weeks gestation arrives to clinic very concerned about the presence of bright red spotting for 2 days. She had her first OB visit at your clinic 2 weeks prior. Which of the following is your likely assessment and the most appropriate next step in your plan of care?

A) Ectopic pregnancy; refer to your consultant physician for management
B) Implantation spotting; reassure her of normalcy
C) Infection; culture her cervix
D) Threatened AB; order an ultrasound

A

D) Threatened AB; order an ultrasound

310
Q

Which of the following pregnant women may continue to exercise if she wishes to do so?

A) 36 weeks with fetal growth restriction
B) 37 weeks with preeclampsia
C) 10 weeks with diagnosed inevitable miscarriage

A

C) 10 weeks with diagnosed inevitable miscarriage

Which is the least bad idea? Consider non-dangerous reasons for bleeding. Varney p. 766-69 for DD 1st trimester bleeding. It is an AB, the first trimester is out of our control. An inevitable AB is just that. Pelvic rest or bed rest does not change outcomes at all (EBR).

311
Q

A CNM/WHNP is seeing a woman in clinic who returns from an ultrasound ordered for abdominal pain and bleeding at 8 weeks gestation. The ultrasound confirms the presence of an ectopic pregnancy. What is the best next course of action?

A) Obtain liver enzymes and order Methotrexate if she is a candidate for medical management of her ectopic
B) Send the woman to the emergency room for additional evaluation
C) Review different options with the woman, then consult/collaborate with the physician for management of the ectopic
D) Discuss options with the woman, have her go home to discuss these with her partner, then make a firm plan when she has made her decision

A

C) Review different options with the woman, then consult/collaborate with the physician for management of the ectopic

312
Q

A woman 7 weeks gestation by LNMP reports an episode of spotting yesterday the size of a 50 cent piece. She reports occasional headache and fatigue. Her uterine size is consistent with her dates. What is the most important data to collect next?

A) Presence of pain
B) Presence of cervical or nabothian cyst
C) Prior history of pregnancy bleeding
D) Urinalysis and culture

A

A) Presence of pain

313
Q

A woman presents at 9 weeks gestation with a report of persistent bright red spotting for 2 days. She had her first visit with you a week ago. The most important part of your care for her would be to:

A) Refer to your consultant physician
B) Obtain an ultrasound
C) Order a CBC with differential
D) Culture her cervix

A

B) Obtain an ultrasound

314
Q

Which of the following is an accurate statement regarding signs and symptoms of ectopic pregnancy?

A) Abdominal pain can be general or localized
B) Serial serum beta hCG levels show decline
C) Urine pregnancy test shows weakly positive
D) An early symptom is syncope

A

A) Abdominal pain can be general or localized

315
Q

Tocolytic drugs are used

A) prior to 36 weeks gestation to stop preterm labor.
B) prior to 35 weeks gestation to prolong pregnancy.
C) prior to 34 weeks gestation to enable corticosteroids to be given.

A

C) prior to 34 weeks gestation to enable corticosteroids to be given.

316
Q

Management of preterm labor includes tocolysis

A) to prevent preterm birth.
B) to prolong pregnancy until 34 weeks gestation.
C) to allow time for cortiocosteroid administration.
D) for fetal neuroprotection.

A

C) to allow time for cortiocosteroid administration.

317
Q

A 38-year-old G4P2012 at 20 weeks gestation is found to have a cervical length of 1.9 cm (19 mm). Her interval history has been benign. The midwife should recognize this woman’s increased risk (R) and recommended management plan (P) as

A) R: cervical insufficiency; P: discuss 17 α-hydroxyprogesterone caproate injections; refer to obstetrician.
B) R: preterm prelabor rupture of membranes; P: discuss cerclage; refer to obstetrician.
C) R: preterm birth; P: educate on vaginal progesterone; collaborate with obstetrician.

A

C) R: preterm birth; P: educate on vaginal progesterone; collaborate with obstetrician.

318
Q

SATA: A single, 22-year-old African American G3P1102 at 31 weeks gestation arrives for evaluation of contractions. On chart review the nurse midwife notes that she has a BMI of 21 and has gained 11 lbs so far. She reports smoking 1/2 pack of cigarettes per day and lives alternately with her mother and with her former boyfriend’s mother as she is currently between jobs and recently lost her apartment and car. Her risk factors for preterm birth include:

A) BMI
B) multiparous
C) smoking
D) race
E) marital status
F) life stress
G) low weight gain
H) history of preterm birth
I) age

A

C) smoking
D) race
F) life stress
G) low weight gain
H) history of preterm birth

319
Q

A G3P2002 at 24 weeks gestation arrives in labor and delivery complaining of leaking clear vaginal fluid. The nurse-midwife’s evaluation reveals
-denial of recent intercourse
-positive vaginal pool
-positive nitrazine
-positive fern
-cervix appears long, closed
-Fetal monitoring category 1
-non-tender uterus, absent uterine contractions
-T 98.4° F P80 R18 BP 110/64

Appropriate assessment (A) and management plan (P) include

A) A: prelabor rupture of membranes(PROM); P: collaborate with obstetrician, baseline vaginal examination, induction of labor.
B) A: preterm prelabor rupture of membranes (PPROM);P: refer to obstetrician, discharge home until reaches age of viability.
C) A: preterm prelabor rupture of membranes (PPROM); P: refer to obstetrician, antibiotics, and corticosteroids.
D) A: prelabor rupture of membranes (PROM); P: collaborate with obstetrician, antibiotics, and magnesium sulfate for neuroprotection.

A

C) A: preterm prelabor rupture of membranes (PPROM); P: refer to obstetrician, antibiotics, and corticosteroids.

320
Q

A potential maternal complication of beta-mimetic tocolytic agents (such as Terbutaline ® and Ritodrine ®) is

A) bradycardia.
B) hypoglycemia.
C) respiratory depression.
D) pulmonary edema.

A

D) pulmonary edema.

321
Q

Regarding women with late-term and postterm pregnancies, the American College of Obstetricians and Gynecologists (ACOG):

A) Recommends against membrane sweeping because it is ineffective.
B) Recommends that induction of labor be carried out by 42 6/7 weeks gestation.
C) States that pregnancies should absolutely not continue past 41 6/7 weeks gestation.

A

B) Recommends that induction of labor be carried out by 42 6/7 weeks gestation.

322
Q

A 28-year-old G1P0 at 33 weeks gestation is experiencing regular contractions and her vaginal exam is 2-3 cm/80%/vertex/-1 with intact membranes. Midwifery management would include

A) ordering indomethacin (Indocin) and magnesium sulfate (for neuroprotection) then refer to a physician.
B) collaboration with a physician to discuss bedrest and the administration of antibiotics.
C) collaboration with an obstetrician to administer antenatal corticosteroids and nifedipine (Procardia) over the next 48 hours.

A

C) collaboration with an obstetrician to administer antenatal corticosteroids and nifedipine (Procardia) over the next 48 hours.

323
Q

Vaginal progesterone is most effective for women with

A) a history of regular contractions prior to 24 weeks.
B) a cervical length of ≤ 20 mm prior to 24 weeks gestation weeks.
C) a history of preterm birth.
D) recurrent bacterial vaginosis.

A

B) a cervical length of ≤ 20 mm prior to 24 weeks gestation weeks.

324
Q

________________ is a significant risk for preterm labor and birth.

A) Prior preterm birth
B) Vaginal bleeding
C) Alcohol use
D) Obesity

A

A) Prior preterm birth

325
Q

A 28 week G3P1102 is being evaluated for a gush of fluid 2 hours ago. Since that time she has not noted any additional fluid leakage. The nurse reports that her vaginal nitrazine was negative. An appropriate assessment (A) and management plan (P) is

A) A: preterm prelabor rupture of membranes (PPROM) vs. intact membranes; P: amnisure, ultrasound for deepest vertical pocket, and sterile vaginal exam.
B) A: intact membranes; P: discharge with preterm labor and prelabor rupture of membranes warnings.
C) A: preterm prelabor rupture of membranes (PPROM) vs. intact membranes; P: sterile speculum exam, visualize cervix, vaginal pool, nitrazine, and perform microscopy for fern.
D) A: preterm prelabor rupture of membranes (PPROM); P: admit, obstetrician referral, GBS culture, corticosteroids.

A

C) A: preterm prelabor rupture of membranes (PPROM) vs. intact membranes; P: sterile speculum exam, visualize cervix, vaginal pool, nitrazine, and perform microscopy for fern.

326
Q

The most accurate prediction of preterm birth is based on

A) frequency of contractions based on the uterine monitor.
B) neither contraction frequency nor intensity are predictive.
C) intensity of contractions based on maternal report.
D) frequency of contractions based on maternal report.

A

B) neither contraction frequency nor intensity are predictive.

327
Q

A 22-year-old G1P0 at 32 6/7 weeks gestation calls the midwife with complaints of backache, pelvic pressure and increased vaginal discharge associated with regular uterine contractions for the past 2-3 hours. She has good fetal movement, no leaking of fluid and no vaginal bleeding. She has been drinking water all day. The midwife should instruct the woman to

A) come to the office for evaluation of preterm labor. Assess the cervical length by utilizing the Cervilenz and palpate abdomen for contractions.
B) lie on her left side for the next few hours, drink 1-2 glasses of water and call back if the symptoms do not resolve.
C) come to the hospital or office for evaluation of preterm labor. Obtain a fetal fibronectin (fFn), transvaginal ultrasound cervical measurement, and cervical digital exam.

A

C) come to the hospital or office for evaluation of preterm labor. Obtain a fetal fibronectin (fFn), transvaginal ultrasound cervical measurement, and cervical digital exam.

328
Q

Postterm pregnancy is associated with an increased risk of

A) perinatal death.
B) maternal infection.
C) neonatal sepsis.
D) prolapsed cord.

A

A) perinatal death.

329
Q

The fetal fibronectin (fFN) test

A) is less reliable than cervical length measurement.
B) best predicts those who will not give birth in the next 2 weeks.
C) will tell you who will most likely will give birth in the next 24-48 hours.
D) is done by taking a sample from the lower third of the vagina.

A

B) best predicts those who will not give birth in the next 2 weeks.

yes, a negative test is fairly accurate in predicting who will NOT go into real preterm labor, and decrease unnecessary intervention

330
Q

A G1P0 at 41 weeks gestation with an uncomplicated pregnancy has a cervical exam of 1cm/soft/50%/middle/-2 (bishop score 6). She is GBS positive. An appropriate assessment (A) and management plan (P) includes

A) A: late-term, unripe cervix; P:strip her membranes, begin fetal surveillance testing.
B) A: late-term, unripe cervix; P: offer expectant management or cervical ripening then induction.
C) A: late-term, ripe cervix; P: schedule an induction of labor with oxytocin.

A

B) A: late-term, unripe cervix; P: offer expectant management or cervical ripening then induction.

331
Q

A 42-year-old G1P0 at 34 weeks gestation has confirmed rupture of membranes. Her group B strep (GBS) is unknown. According to ACOG recommendations, appropriate management includes

A) Provide expectant management; obtain group B strep (GBS) culture; give betamethasone 12mg now and repeat in 24 hours; prophylactic antibiotics; collaborate with MD.
B) Perform a vaginal exam for baseline; discuss expectant versus active management and collaborate with an obstetrician.
C) Discuss active management due to an increased risk of infection, group B strep (GBS) intrapartum prophylaxis,consider corticosteroid administration, collaborate with an obstetrician, and plan neonatal provider at birth.

A

C) Discuss active management due to an increased risk of infection, group B strep (GBS) intrapartum prophylaxis,consider corticosteroid administration, collaborate with an obstetrician, and plan neonatal provider at birth.

332
Q

For a woman presenting with regular, preterm contractions, which of the following should be considered?

A) Antibiotics to prolong the pregnancy and prevent preterm birth.
B) A tocolytic drug now and for maintenance therapy until term.
C) Bed rest, hydration, and pelvic rest.
D) Fetal fibronectin testing and transvaginal ultrasound for cervical length.

A

D) Fetal fibronectin testing and transvaginal ultrasound for cervical length.

The evidence does not support antibiotic use in preventing preterm birth and there can be negative outcomes as a result of its use. A tocolytic drug may be useful in prolonging pregnancy by 2-7 days with preterm labor, providing enough time for transport to a facility with a NICU and for administering glucocorticoids to aid with fetal lung maturity. There is no evidence of benefit with prescribed bed rest, pelvic rest, and hydration as measures to prevent preterm birth; some harm is possible with prescribed bed rest (e.g., thrombosis, loss of income, psychosocial stress).

333
Q

According to the current evidence on the use of corticosteroids in preterm labor (PTL) ACOG recommends

A) regularly scheduling repeat courses of corticosteroids with the continued
threat of preterm birth.
B) a single course of corticosteroids between 24 and 34 weeks gestation with a threat of preterm birth within 7 days.
C) betamethasone as the most effective corticosteroid.
D) an accelerated course of corticosteroids when preterm birth appears imminent.

A

B) a single course of corticosteroids between 24 and 34 weeks gestation with a threat of preterm birth within 7 days.

334
Q

A postterm pregnancy is technically defined as a pregnancy that continues to

A) 41-1/7 (287 days) completed weeks or longer
B) 42-0/7 (294 days) completed weeks or longer
C) 40-1/7 (281 days) completed weeks or longer
D) 42-0/7 (287 days) completed weeks or longer

A

B) 42-0/7 (294 days) completed weeks or longer

Postterm is the due date plus 2 weeks, or 40 completed weeks plus 2 weeks, or 42 completed weeks. 42 x 7 = 294 days. A completed week is the same thing as a week when discussing gestational age. One completed week = 7 days = one week…40 completed weeks = 280 days = 40 weeks.

335
Q

Treatment of Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP) includes

A) Narrowband ultraviolet B, short course of systemic corticosteroids.
B) Cutting nails short, ursodeoxycholic acid (Actigall), vitamin K supplements.
C) anti-pruritic lotion with menthol, low to mid potency topical steroids, antihistamines.

A

C) anti-pruritic lotion with menthol, low to mid potency topical steroids, antihistamines.

336
Q

A G3P2002 at 30 weeks gestation complains of intense generalized itching noticeably worse on her soles and palms. Examination reveals excoriations from scratching but no underlying rash. The nurse-midwife is suspicious of

A) polymorphic eruption of pregnancy (PEP)
B) pemphigoid gestationis (PG).
C) interhepatic cholestasis of pregnancy (ICP).
D) atopic eruption of pregnancy (AEP).

A

C) interhepatic cholestasis of pregnancy (ICP).

Varney page 793-794. intense itching without a rash is highly suggestive of IHCP. This condition is of high concern because of the association with stillbirth.

337
Q

A 36 week G1P0 presents with a severely itchy rash on her abdomen, buttocks, and thighs. The rash was first noted within her stretch marks. On examination papules and urticarial lesions are noted. The umbilical region is free of the rash. Appropriate assessment (A) and management plan (P) includes

A) A: Atopic eruption of pregnancy (AEP); P: Reassure benign disorder, discuss comfort measures, order low potency topical steroid.
B) A: Pruritic urticarial papules and plaques of pregnancy (PUPPP); P: Reassure benign disorder, discuss comfort measures, order antihistamines and low potency topical steroid.
C) A: Intrahepatic cholestasis of pregnancy (ICP); P: Collaborate with obstetrician, order bile acids and liver enzymes, order ursodeoxycholic acid (Actigall) and antenatal testing.
D) A: Pemphigold Gestationis (PG); P: Collaborate with obstetrician, refer to dermatologist, schedule antenatal testing.

A

B) A: Pruritic urticarial papules and plaques of pregnancy (PUPPP); P: Reassure benign disorder, discuss comfort measures, order antihistamines and low potency topical steroid.

338
Q

A G3P2002 at 15 weeks gestation reports that she is having difficulty with eczematous lesions in the creases of her arms and legs as well as her face, neck and trunk. She had similar lesions during her last pregnancy that cleared a few months after delivery. The nurse-midwife explains this is a condition called

A) atopic eruption of pregnancy (AEP).
B) pemphigoid gestationis (PG)>
C) interhepatic cholestasis of pregnancy (ICP).
D) pruritic urticarial papules and plaques of pregnancy (PUPPP).

A

A) atopic eruption of pregnancy (AEP).

Varney page 792. The classic presentation of AEP is intense itching with popular, eczematous lesions beginning in the 1st or 2nd trimester.

339
Q

A 34-year-old G4P3003 at 36 weeks gestation reports intense itching of the hands and feet. Physical exam reveals excoriations from scratching without a visible rash. Lab results show an elevation in total serum bile acids, cholic acid, and liver enzymes. Appropriate assessment (A) and management plan (P) includes

A) A:Phemphigoid gestationis (PG); P: prescribe hydroxyzine (Vistaril) and hydrocortisone cream.
B) A: Pruritic urticarial papules and plaques of pregnancy (PUPPP); P: prescribe diphenhydramine (Benedryl) and hydrocortisone cream and begin weekly biophysical profile testing.
C) A: intrahepatic cholestasis of pregnancy (ICP); P: prescribe ursodeoxycholic acid (Actigall), begin biweekly fetal surveillance testing.
D) A: Atopic eruption of pregnancy (AEP) ; P: prescribe hydrocortisone and plan induction of labor at 37 weeks.

A

C) A: intrahepatic cholestasis of pregnancy (ICP); P: prescribe ursodeoxycholic acid (Actigall), begin biweekly fetal surveillance testing.

340
Q

Intrahepatic cholestasis of pregnancy (ICP) is associated with

A) steatorrhea, postpartum hemorrhage, meconium stained fluid, and stillbirth.
B) long-term increase risk of Grave’s disease, preterm birth and low birthweight.
C) no known maternal or fetal risks.

A

A) steatorrhea, postpartum hemorrhage, meconium stained fluid, and stillbirth.

341
Q

The abrupt onset of pruritic lesions on the trunk or abdomen during the third trimester of pregnancy is likely indicative of:

A) An acne exacerbation associated with the increased oil production normally seen in pregnancy.
B) PUPPPs (Pruritic urticarial papules and plaques of pregnancy- also known as PEP (polymorphic eruption of pregnancy).
C) Pregnancy-related eczema exacerbation.
D) The normal changes in the underlying skin matrix that occur when the skin is stretched.

A

B) PUPPPs (Pruritic urticarial papules and plaques of pregnancy- also known as PEP (polymorphic eruption of pregnancy).

342
Q

A 32-year-old woman at 35 weeks gestation is diagnosed with pruritic urticarial papules and plaques of pregnancy (PUPPP). Her pregnancy history reveals she is also a gestational diabetic on metformin. She is concerned about her baby and how to stop the itching. The midwife responds

A) “A PUPPPs rash may cause liver damage and therefore we will need to consider an earlier delivery between 37 and 38 weeks gestation.”
B) “A PUPPPs rash is related to an increased risk of pregnancy complications. We can treat you with oral prednisone and ursodeoxycholic acid (Actigall) and monitor the baby closely.”
C) “A PUPPPs rash has not been found to harm you or your baby. The best we can do is treat the symptoms. Let’s try diphenhydramine (Benadryl) and a low-potency topical steroid lotion first.”

A

C) “A PUPPPs rash has not been found to harm you or your baby. The best we can do is treat the symptoms. Let’s try diphenhydramine (Benadryl) and a low-potency topical steroid lotion first.”

343
Q

Which of the following is true concerning Pemphigoid Gestationis (PG)?

A) PG is NOT associated with adverse perinatal outcomes.
B) PG is characterized by exacerbations and remissions during pregnancy.
C) PG often involves the face and scalp.
D) PG is most pronounced in the first trimester.

A

B) PG is characterized by exacerbations and remissions during pregnancy.

344
Q

Pemphigoid Gestationis (PG) can be differentiated from pruritic urticarial papules and plaques of pregnancy (PUPPP) by the fact that the rash

A) appears as eczematous lesions typically in extremity creases.
B) spares the periumbilical area.
C) may spread to the palms and soles.
D) goes into remission approximately 4 weeks later.

A

C) may spread to the palms and soles.

Varney page 794-795. PG is an uncommon condition but it’s associated with poor fetal outcomes including IUGR and preterm birth

345
Q

PUPPP lesions are most frequently found on the:

A) trunk and extremities
B) palms of the hands
C) soles of the feet
D) face

A

A) trunk and extremities

346
Q

At 34 weeks gestation a G1P0 complains of an abdominal rash accompanied with intense itching that began in her stretch marks and spread. On examination erythematous, edematous papules covering the abdomen are noted. The periumbilical area is spared. The nurse-midwife

A) schedules an ultrasound for fetal growth.
B) orders liver function studies and total bile acids.
C) schedules biweekly fetal surveillance testing.
D) reassures the woman that the condition is not associated with adverse outcomes for mom or baby.

A

D) reassures the woman that the condition is not associated with adverse outcomes for mom or baby.

Varney page 795. Although PUPPS is uncomfortable, it is not associated with poor maternal/fetal outcomes and rarely occurs in subsequent pregnancies.

347
Q

Amniotic fluid volume:

A) is normal if measurement is between 4-10 cms
B) is a direct measure of fetal sympathetic nervous system function
C) varies by gestational age
D) should be done along with an NST for a report of decreased FM

A

C) varies by gestational age

348
Q

Which patient education point must be included when discussing fetal movement counts?

A) chart how long it takes to feel five fetal movements.
B) count fetal movements several times each week.
C) count fetal movements prior to a meal.
D) report any decrease in fetal movement.

A

D) report any decrease in fetal movement.

349
Q

A contraction stress test (CST):

A) uses Pitocin to stimulate contractions
B) is the preferred fetal screening test for post-dates management
C) measures the fetal response to 3 contractions in 20 minutes
D) is negative when a late deceleration is seen after a contraction

A

A) uses Pitocin to stimulate contractions

Varney p. 806. CST uses pitocin. Checks fetal response to 3 contractions in a 10 min window. Low false negatives. High false positives. The compromised fetus will respond with a late deceleration.

350
Q

A fetal heart rate in the 170s for 15 minutes should be described as:

A) Tachycardia
B) A normal baseline
C) An acceleration
D) Bradycardia

A

A) Tachycardia

ACOG Practice Bulletin No. 106: Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles Table 1. p. 3

351
Q

Which of the following is an accurate statement regarding fetal movement counting?

A) Hypothyroidism can reduce fetal movement in the 3rd trimester
B) Women should be advised to start fetal movement counting by 26 weeks gestation
C) The amplitude of fetal movement decreases as the amniotic volume decreases
D) Women perceive fetal movement the most when standing

A

C) The amplitude of fetal movement decreases as the amniotic volume decreases

352
Q

Which of the following statements regarding non-stress tests (NSTs) is true?

A) Serial NSTs are indicated after maternal report of decreased fetal movement
B) Using vibroaccoustic stimulation (VAS) and increasing the length of the NST results in more reactive tests
C) All women should have an NST and amniotic fluid index (AFI) at 40 weeks gestation
D) Most fetuses with a nonreactive NST are acidotic

A

B) Using vibroaccoustic stimulation (VAS) and increasing the length of the NST results in more reactive tests

353
Q

Parameters scored on the biophysical profile (BPP) are:

A) Placental location, fetal muscle tone, and amniotic fluid
B) Fetal body movements, fetal breathing movements, and amniotic fluid
C) Fetal muscle tone, fetal position, and fetal body movements
D) Fetal heart rate, fetal breathing movements, and fetal position

A

B) Fetal body movements, fetal breathing movements, and amniotic fluid

354
Q

A nonreactive non-stress test (NST) should be subsequently evaluated with which of the following:

A) Biophysical profile (BPP)
B) Doppler velocimetry studies
C) Modified BPP
D) Repeat NST in 24 hours

A

A) Biophysical profile (BPP)

355
Q

A 30-year-old G1P0 at 14 weeks gestation presents to clinic concerned because she has not yet felt fetal movement. Fetal heart tones are auscultated by Doppler at 140 beats per minute. The most appropriate response by the CNM/WHNP is to:

A) Reassure her of normalcy and tell her she is likely to feel fetal movement by 20 weeks
B) Offer an in-office ultrasound to visualize the fetus
C) Tell her she is likely to feel fetal movement within the next week
D) Reassess the fetal heart tones

A

A) Reassure her of normalcy and tell her she is likely to feel fetal movement by 20 weeks

356
Q

Mary is a 27 year old G1P0 at 38 weeks gestation. She calls you to report that her baby moved 1 time after eating and drinking and counting for 2 hours; her baby usually moves 8-10 times in that situation. Your next best actions is to:

A) Consult your collaborating MD about a possible induction
B) Advise her to go to labor and delivery for a CST & monitoring
C) Have her come in to the office for an NST
D) Advise her to drink cold liquids and count for 30 more minutes and then call you back.

A

C) Have her come in to the office for an NST

357
Q

Which of the following statements is accurate?

A) When an NST is reactive, a CST is advised.
B) Vibroacoustic stimulation (VAS) should be done with a positive CST.
C) When an auscultated acceleration test (AAT) is done, it should be followed up with an NST.
D) AFI is a measurement of the sum of amniotic fluid in all 4 quadrants

A

D) AFI is a measurement of the sum of amniotic fluid in all 4 quadrants

358
Q

A woman is 12 weeks gestational age confirmed by a 7-week ultrasound. The midwife is unable to locate fetal heart tones with a doppler. Which is the next most appropriate step?

A) order an ultrasound.
B) inform the client that it is too early to hear FHTs.
C) reassess the fetal gestational age.
D) rule out ectopic pregnancy.

A

A) order an ultrasound.

359
Q

A visually apparent abrupt increase in the FHR with a peak of 15 beats per minute or more above baseline and a duration of 15 seconds or more

A) Acceleration
B) Baseline variability
C) Short-term variability
D) Long-term variability

A

A) Acceleration

360
Q

A 24-year-old G3P2002 at 38 weeks gestation comes in to labor and delivery reporting decreased fetal movement today. Her history includes the following: She works 30 hours per week as a cashier at a large chain store and smokes ½ pack per day (she has cut down from 1 PPD). Which of the following is most pertinent for subjective data gathering?

A) Time of last meal
B) How many hours she had to stand at work yesterday
C) 24 hour dietary recall
D) Smoking pattern today

A

D) Smoking pattern today

361
Q

Recurrent decelerations occur:

A) At least 8 times in a 20-minute period.
B) With at least 50% of contractions in a 20-minute period.
C) At least 4 times in a 20-minute period.
D) With less than 50% of contractions in a 20-minute period.

A

B) With at least 50% of contractions in a 20-minute period.

ACOG Practice Bulletin No. 106: Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles p. 2, “Decelerations are defined as recurrent if they occur with at least one-half of the contractions.”

362
Q

A biophysical profile (BPP) for decreased fetal movement at 32 weeks gestation reveals an amniotic fluid index (AFI) of 5 centimeters. The nurse-midwife is aware that this finding may be related to

A) esophageal atresia and may cause difficulty palpating fetal parts.
B) placental insufficiency and increases the risk of variable fetal heart rate decelerations.
C) gestational diabetes and may decrease the risk of meconium aspiration syndrome (MAS).

A

B) placental insufficiency and increases the risk of variable fetal heart rate decelerations.

363
Q

Which of the following statements regarding NST is true?

A) Serial NST’s are required after a report of decreased fetal movement near term
B) Most fetuses with a nonreactive NST are not healthy
C) VAS and waiting longer increases reactivity
D) The maximum duration ranges from 60 minutes to 90 minutes

A

C) VAS and waiting longer increases reactivity

364
Q

A woman presents to clinic at 12 weeks gestation by sure LMP for prenatal care and tells the midwife she does not want to have any ultrasounds or to use the doppler to monitor fetal heart tones during her prenatal care. The midwife knows that:

A) the woman should seek care elsewhere because listening to fetal heart tones is a requirement of CNM-provided care.
B) a fetoscope can be used to auscultate fetal heart tones but not until the third trimester.
C) fetal heart tones are only possible to hear with a doppler during clinic visits, so the best way to monitor fetal wellbeing is by asking her about fetal movement.
D) a fetoscope may be used at the next regular prenatal visit to auscultate fetal heart tones.

A

D) a fetoscope may be used at the next regular prenatal visit to auscultate fetal heart tones.

365
Q

A visually apparent decrease in the FHR, at least 15 beats per minute below the baseline, that continues for at least 2 minutes but less than 10 minutes.

A) Prolonged deceleration
B) Variable deceleration
C) Late deceleration
D) Early deceleration

A

A) Prolonged deceleration

ACOG Practice Bulletin No. 106: Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles Table 1 p.3. Varney p. 927-928.

366
Q

Which of the following influences maternal perception of fetal movement?

A) Maternal activity
B) Maternal bladder status
C) Maternal fatigue level
D) Maternal weight

A

A) Maternal activity

367
Q

The mean FHR rounded to increments of 5 beats per minute during a 10-minute segment, excluding periodic or episodic changes is

A) Prolonged deceleration
B) Variable deceleration
C) Baseline variability
D) Baseline

A

D) Baseline

ACOG Practice Bulletin No. 106: Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles Table 1 p. 3

368
Q

Which of the following statements regarding non-stress tests (NSTs) is true?

A) All women should have an NST and amniotic fluid index (AFI) at 40 weeks gestation
B) Most fetuses with a nonreactive NST are acidotic
C) Using vibroaccoustic stimulation (VAS) and increasing the length of the NST results in more reactive tests
D) Serial NSTs are indicated after maternal report of decreased fetal movement

A

C) Using vibroaccoustic stimulation (VAS) and increasing the length of the NST results in more reactive tests

369
Q

Which of the following is an effective intrauterine resuscitation technique:

A) Oxytocin augmentation to hasten labor and birth
B) Artificial rupture of membranes
C) Lateral positioning
D) Decreasing maternal blood pressure

A

C) Lateral positioning

Varney p. 936 Table 26-8. Maternal positioning is a component of corrective measures for variable, late and prolonged decelerations.

370
Q

Parameters scored on the biophysical profile (BPP) are:

A) Placental location, fetal muscle tone, and amniotic fluid
B) Fetal muscle tone, fetal position, and fetal body movements
C) Fetal heart rate, fetal breathing movements, and fetal position
D) Fetal body movements, fetal breathing movements, and amniotic fluid

A

D) Fetal body movements, fetal breathing movements, and amniotic fluid

371
Q

Continuous electronic fetal heart rate monitoring is associated with

A) Decreased infant mortality
B) Decreased cerebral palsy
C) Decreased neonatal seizure
D) Increased cesarean births

A

D) Increased cesarean births

ACOG Practice Bulletin No. 106: Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles p. 5, “The use of EFM compared with intermittent auscultation

372
Q

A visually apparent, symmetrical, gradual decrease and return of the FHR, delayed in its onset relative to the onset of a uterine contraction with the FHR nadir occurring after the peak of the contraction, and with its return typically occurring after the end of the contraction.

A) Baseline variability
B) Early deceleration
C) Variable deceleration
D) Late deceleration

A

D) Late deceleration

ACOG Practice Bulletin No. 106: Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles p. 3 Table 1

373
Q

The presence of accelerations in the FHR generally indicates

A) Maternal hypotension
B) The need for intrauterine resuscitation
C) Fetal intolerance to labor
D) The fetus is not acidemic

A

D) The fetus is not acidemic

Varney p. 923 “98% of fetuses with moderate variability will not have clinically significant acidemia.”

374
Q

A 22 year old G2P1001 smoker at 38 weeks comes in for antenatal surveillance. Her nonstress test is equivocal; BPP 6/8 (2 off for fluid); AFI 4.8. Her cervical exam is 1cm/80%/posterior with a ballotable head. Which of the following is the most appropriate management plan?

A) Repeat the NST after she hasn’t smoked for at least 30 minutes.
B) Send her home with strict fetal movement counting instructions.
C) Discuss with consulting physician and initiate induction immediately.
D) Repeat a biophysical profile in 24 hours.

A

C) Discuss with consulting physician and initiate induction immediately.

375
Q

All of the following are indications for an NST EXCEPT:

A) Placenta previa
B) Preeclampsia
C) Oligohydramnios
D) History of IUGR

A

A) Placenta previa

376
Q

According to the ACOG bulletin on FHR monitoring, for a woman without complications, which is the best choice for fetal assessment?

A) Intermittent auscultation
B) Application of electronic fetal monitor for 10 minutes every hour
C) Continuous electronic fetal monitoring
D) Either continuous electronic fetal monitoring or intermittent auscultation is acceptable

A

D) Either continuous electronic fetal monitoring or intermittent auscultation is acceptable

“Given that the available data do not show a clear benefit for the use of EFM over intermittent auscultation, either option is acceptable in a patient without complications.” ACOG Practice Bulletin No. 106: Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles p. 5.

377
Q

Following a nonreactive NST for a woman at 41 weeks gestation, a BPP was performed. The following results were obtained: one 6 cm. X 2 cm. deep vertical pocket of amniotic fluid, one 10 second sustained period of fetal breathing movements, two gross body movements, and one episode of flexion/extension of the arms and legs. Based upon these results, what is the best management plan?

A) Schedule a modified BPP in 48 hours
B) Recommend bed rest with increased fluid intake and repeat the BPP in 24 hours
C) Reassure the woman of the normalcy of the test results and schedule a routine follow-up visit
D) Recommend the woman go to labor and delivery for additional evaluation and management

A

D) Recommend the woman go to labor and delivery for additional evaluation and management

378
Q

The biophysical profile (BPP) measures:

A) Respiratory activity, tone , gross movements
B) Fetal heart rate, position, gross movements
C) Muscle tone, position, respiratory activity
D) Amniotic fluid volume, tone, estimated fetal weight

A

A) Respiratory activity, tone , gross movements

379
Q

Which of the following is the correct way to instruct women to perform routine fetal movement counting?

A) Fetal movement counting should be done daily beginning at 26 weeks to decrease the number of term fetal demises
B) Do fetal movement counts at the same time each day
C) It is best to do fetal movement counting first thing in the morning and after meals
D) There are several ways of instructing women to do fetal movement counts and one method has not been shown to be better than any other

A

D) There are several ways of instructing women to do fetal movement counts and one method has not been shown to be better than any other

380
Q

A woman had a biophysical profile at 40.5 weeks gestation. Her score is 8/8. This test indicates:

A) that NST was not done
B) inadequate amniotic fluid index
C) reduced body movement
D) increased risk of fetal asphyxia

A

A) that NST was not done

381
Q

Which statement about diabetes and shoulder dystocia is TRUE?

A) Diabetes is a risk factor for shoulder dystocia because it impacts the head to shoulder ratio.
B) Diabetes is a risk factor for shoulder dystocia only if a woman has uncontrolled blood sugars.
C) Diabetes is a risk factor for shoulder dystocia only if the fetal weight exceeds 4500 grams.

A

A) Diabetes is a risk factor for shoulder dystocia because it impacts the head to shoulder ratio.

382
Q

A 29 year old Hispanic G1P0 with a body mass index (BMI) of 30.5 returns for her 2nd visit at 12 weeks gestation. She had a normal 1 hour 50 g glucose screen at her first visit. It is appropriate to

A) have her do home urine glucose monitoring.
B) advise a repeat 1 hour 50 g glucose screen at 24 -28 weeks gestation.
C) have her do fasting blood sugar and 2 hour postprandial home testing.
D) obtain a 3 hour 100 g glucose tolerance test at 24-28 weeks gestation.

A

B) advise a repeat 1 hour 50 g glucose screen at 24 -28 weeks gestation.

383
Q

A 30-year-old G1P0 has an early 1-hour oral glucose tolerance test (OGTT). The results were 128 mg/dL. The most appropriate plan would include having her

A) repeat a 1-hour oral glucose tolerance test (OGTT) between 24-28 weeks.
B) record food intake until the next visit.
C) start once daily fasting glucose self-monitoring.
D) do a 3-hour oral glucose tolerance test (OGTT) by the next visit.

A

A) repeat a 1-hour oral glucose tolerance test (OGTT) between 24-28 weeks.

384
Q

Compared to non-pregnant women, normal fasting glucose blood levels in pregnant women are:

A) unchanged
B) variable depending on BMI
C) lower
D) higher

A

C) lower

385
Q

Which woman has the highest priority for early screening for gestational diabetes mellitus (GDM)?

A) BMI 25.5; multiparous
B) BMI 27.2; sister with GDM
C) BMI 21.2; Previous baby birth weight 11 pounds
D) BMI 26; age 46

A

B) BMI 27.2; sister with GDM

386
Q

An appropriate management plan for a gestational diabetic pregnancy with good glycemic control with diet and exercise includes

A) antepartum fetal surveillance testing beginning at 32 weeks gestation.
B) induction of labor at 38 weeks gestation.
C) expectant management up to 41 weeks gestation.

A

C) expectant management up to 41 weeks gestation

387
Q

A 22 year old at 28 weeks gestation had a 1 hour 50 g glucose screen of 148 mg/dL followed by a 3 hour 100 g glucose tolerance test (GTT) with the following values
fasting 106 mg/dL
1 hour 185 mg/dL
2 hour 172 mg/dL
3 hour 136 mg/dL
This result

A) indicates glucose intolerance with one abnormal value by national diabetes data groups’ (NDDG) criteria.
B) is normal by Carpenter and Coustan criteria.
C) indicates gestational diabetes (GDM) by national diabetes data groups’ (NDDG) criteria

A

C) indicates gestational diabetes (GDM) by national diabetes data groups’ (NDDG) criteria

388
Q

A 28 year-old at 33 weeks gestation was diagnosed with gestational diabetes 3 weeks ago. Her blood sugar ranges in the last week were: Fasting: 95 – 110mg/dL; 2 hour post prandial: 118 – 165 mg/dL. The most appropriate management plan is

A) collaborate with an obstetrician for consideration of insulin or metformin and refer to the diabetic educator for further education.
B) obtain a 1-week dietary recall and encourage the woman to increase her exercise to 30 minutes daily.
C) continue current management plan and add weekly non-stress tests and fetal kick counts at 34 weeks gestation.

A

A) collaborate with an obstetrician for consideration of insulin or metformin and refer to the diabetic educator for further education.

389
Q

SATA: A 27 year old South Asian (India) G2P1001 arrives for her first visit at 11 weeks gestation. Her body mass index (BMI) is 25 and she has gained 4 lbs so far. Her OB history discloses a vaginal delivery of a 7 lb 8 oz baby boy 2 years ago. Her family history reveals a paternal aunt with diabetes. According to American College of Obstetricians and Gynecologists (ACOG) early screening criteria a one hour 50 g glucose screen is indicated because of her

A) age.
B) ethnicity.
C) body mass index (BMI).
D) OB history.
E) weight gain.
F) family history.

A

B) ethnicity.
C) body mass index (BMI).

390
Q

The midwife is seeing a woman for a 28-week prenatal visit. According to the woman’s chart, her blood type is O negative, negative antibody titer (indirect coombs), and her 1-hour glucose tolerance test (GTT) was 210 mg/dL. On exam her fundal height is 32 cm. The midwife should

A) refer to an obstetrician for diabetes management and polyhydramnios.
B) order an ultrasound , send to a diabetic educator, and give rhogam.
C) schedule a 3-hour glucose tolerance test (GTT) in 1 week.
D) reassure her that everything looks great and her next appointment is in 2 weeks.

A

B) order an ultrasound , send to a diabetic educator, and give rhogam.

391
Q

A 43-year-old G2 P1 arrives at the clinic for her visit at 28 weeks gestation. She had gestational diabetes and preeclampsia with her first pregnancy. Her pre-gravid BMI was 26. Today her BP is 128/76, she has gained 15 total pounds, and her fundal height is 34 cm. The midwife should:

A) order baseline preeclampsia labs.
B) consult with the obstetrician.
C) order a 1-hour glucose tolerance test.
D) transfer the woman to physician care.

A

C) order a 1-hour glucose tolerance test.

392
Q

A woman is 10 weeks gestation. Which indicates a need for an early 1-hour glucose test?

A) previous child weighed 10.5 pounds at birth
B) maternal great-grandmother had type 2 diabetes.
C) history of one early second trimester miscarriage
D) BMI of 23 and three pound total weight gain

A

A) previous child weighed 10.5 pounds at birth

393
Q

A woman at 29 weeks’ gestation is a newly diagnosed gestational diabetic. Her body mass index (BMI) is 20.5 with a total weight gain of 19 lbs. The midwife understands that priority assessments of her gestational diabetes includes blood sugars, diet, weight and exercise pattern, and

A) uterine activity.
B) fundal height.
C) work hours.
D) amniotic fluid index (AFI).

A

B) fundal height.

394
Q

A midwifery practice has a policy of universal gestational diabetes screening. A pregnant woman at 28 weeks gestation states she will not drink the glucose solution because it is “full of toxic substances.” What is the best approach to the situation?

A) Discuss the possibility of discharging the woman from the practice.
B) Suggest the possibility of informed refusal, then propose avenues for changing the current guideline.
C) Explain the reasons for gestational diabetes diagnosis, testing, and treatment, then provide time for the woman to ask questions.
D) Provide several evidence-based journal articles on the potential morbidities associated with gestational diabetes, then have the woman return to the clinic in 3 weeks to discuss.

A

C) Explain the reasons for gestational diabetes diagnosis, testing, and treatment, then provide time for the woman to ask questions.

395
Q

Which statement about diabetes and shoulder dystocia is TRUE?

A) Diabetes is a risk factor for shoulder dystocia because it impacts the head to shoulder ratio.
B) Diabetes is a risk factor for shoulder dystocia only if the fetal weight exceeds 4500 grams.
C) Diabetes is a risk factor for shoulder dystocia only if a woman has uncontrolled blood sugars.

A

A) Diabetes is a risk factor for shoulder dystocia because it impacts the head to shoulder ratio.

396
Q

A 36 year old G3P2002 at 32 weeks gestation with diet controlled gestational diabetes has a fundal height measurement of 35 centimeters. Fetal parts are difficult to palpate with leopolds. The clinician diagnoses polyhydramnios because the ultrasound shows:

A) deepest vertical pocket of 4 cm
B) deepest vertical pocket of 6 cm
C) amniotic fluid index of 22 cm
D) amniotic fluid index of 30 cm

A

D) amniotic fluid index of 30 cm

397
Q

Which of the following characteristics does NOT indicate a high risk for gestational diabetes (GDM)?

A) a history of GDM
B) impaired glucose metabolism
C) BMI >30
D) diet recall high in simple carbohydrates

A

D) diet recall high in simple carbohydrates

398
Q

A 31 year-old G2P1001 is diagnosed at 28 weeks with gestational diabetes. This is her first weekly visit after attending the gestational diabetic class and beginning her fasting blood sugar (FBS) and 2 hour post prandial testing. Review of her blood sugar log reveals fasting blood sugars (FBS) between 90 and 95 mg/dL and 2 hour post prandial sugars between 118 – 140 mg/dL. The most appropriate management plan includes

A) collaborate with an obstetrician for consideration of insulin or metformin.
B) review dietary recall, provide diet counseling and increase daily exercise to 30 minutes.
C) continue current management plan and begin fetal surveillance testing.

A

B) review dietary recall, provide diet counseling and increase daily exercise to 30 minutes.

399
Q

Mild glycosuria in pregnancy:

A) is abnormal and may indicate gestational diabetes.
B) is due to increased glomerular filtration rate (GFR) and is normal in pregnancy.
C) requires additional evaluation by a nephrologist.
D) is due to increased carbohydrate intake normally found in the diets of pregnant women.

A

B) is due to increased glomerular filtration rate (GFR) and is normal in pregnancy.

400
Q

A G2P1001 at 20 weeks gestation presents to labor and delivery triage complaining of worsening nausea and vomiting accompanied by diffuse abdominal pain since yesterday. She hasn’t eaten since yesterday. Her vital signs are T 99.2 ° F, P 90, R 20, BP 120/80. Her physical exam is positive for pinpoint tenderness to the right upper quandrant (RUQ) guarding, and rebound. The costovertebral angle (CVA) is non-tender. An appropriate assessment (A) and management plan (P) includes

A) A: renal calculi vs. pylenephritis; P: Order complete blood count (CBC),urinalysis, urine culture, renal ultrasound and collaborate with obstetrician.
B) A: appendicitis vs. cholecystitis;P; Order serial complete blood count (CBC) with differential, liver enzymes, ultrasound of appendix and gallbladder, collaborate with obstetrician.
C) A: cholecystitis vs. pancreatitis; P: Order complete blood count (CBC) with differential, liver enzymes, amylase, ultrasound of gallbladder and pancreas, consult with obstetrician.

A

B) A: appendicitis vs. cholecystitis;P; Order serial complete blood count (CBC) with differential, liver enzymes, ultrasound of appendix and gallbladder, collaborate with obstetrician.

Varney page 195-196. Both appendicitis and cholecystitis are conditions that require prompt surgical referral.

401
Q

A client is diagnosed with gallstones at 36 weeks gestation without any pancreatic involvement. Her management plan includes

A) morphine for pain management.
B) medical management including a low fat diet.
C) medical management including a high protein diet.
D) surgical management with a laparoscopic cholecystectomy

A

B) medical management including a low fat diet.

402
Q

A 32-year-old G3P2002 with a history of gastric bypass surgery presents with symptoms of heartburn, abdominal pain, and uterine cramping. The CNM/WHNP’s differential diagnosis should include:

A) Dumping syndrome
B) Hernias and intestinal obstruction
C) Cholelithiasis
D) Deficiency in calcium absorption

A

B) Hernias and intestinal obstruction

403
Q

A G3P2002 at 35 weeks gestation reports sudden onset of stabbing right upper quadrant abdominal pain, nausea and vomiting. She denies any contractions, vaginal leaking of fluid or vaginal bleeding. The physical exam reveals: Temp 100.4, pulse 103, respiration 22; BP 140/86; FHTs 168 category 1; abdomen tender on the upper right quadrant radiating into the right flank; positive Murphy sign; uterus soft with irregular uterine contractions; no vaginal bleeding; deep tendon reflexes (DTRs) 1+; negative clonus; 1+ pretibial edema. Urinalysis protein negative. Appropriate assessment (A) and management plan (P) includes

A) A: preeclampsia; P: order complete blood count (CBC) and liver enzymes; refer to an obstetrician.
B) A: appendicitis; P: order complete blood count (CBC) with differential and abdominal ultrasound; consult with obstetrician and general surgeon.
C) A: abruptio placenta; P: order complete blood count (CBC), Kleihaure- Betke, and abdominal ultrasound; consult with obstetrician.
D) A: acute cholecystitis; P: order complete blood count (CBC) with differential, serum lipase, liver function tests, and gallbladder ultrasound; consult with obstetrician and general surgeon.

A

D) A: acute cholecystitis; P: order complete blood count (CBC) with differential, serum lipase, liver function tests, and gallbladder ultrasound; consult with obstetrician and general surgeon.

404
Q

A 28-week gestation G2P1001 presents to the OB triage unit with a complaint of worsening right upper quadrant pain, nausea and vomiting. Examination of the abdomen elicits tenderness in the right quadrant adjacent to the umbilicus along with abdominal guarding. She is afebrile, BP 120/80, P 92, R 20. An appropriate laboratory work-up would include

A) serial white blood cell (WBC) counts with differential, serum lipase, and liver enzymes.
B) triglycerides, serum amylase, and urine culture.
C) complete blood count (CBC), serum creatinine, and blood urea nitrogen (BUN).
D) electrolytes, total serum bilirubin (TSB) and direct bilirubin.

A

A) serial white blood cell (WBC) counts with differential, serum lipase, and liver enzymes.

405
Q

Intravenous fluids in women with pre-eclampsia

A) can be used if they are a hypertonic solution.
B) must be used carefully to avoid pulmonary and cerebral edema.
C) can be given as a bolus in an attempt to expand blood volume.

A

B) must be used carefully to avoid pulmonary and cerebral edema.

406
Q

A 36 year old G1P0 African American woman at 34 weeks gestation comes in for her routine visit. Her prenatal course to this point has been uneventful. Today her BP is 150/94. Her repeat BP 4 hours later is 148/90. Additional assessments should include

A) weight loss.
B) left upper quandrant pain.
C) deep tendon reflexes (DTRs).
D) urine bilirubin.

A

C) deep tendon reflexes (DTRs).

407
Q

At a routine prenatal visit, a 38-year-old, G1P0 at 35 weeks gestation complains of blurred vision over the past few days and a headache unresponsive to Tylenol or rest. Her BP is 145/90 mmHg and she has 1+ proteinuria on a dip stick. What is most likely her diagnosis?

A) Preeclampsia with non-severe features
B) Gestational hypertension
C) Severe migraine headache
D) Preeclampsia with severe features

A

D) Preeclampsia with severe features

408
Q

A 34-year-old G4P3003 at 10 weeks gestation reports a history of chronic hypertension. Her BMI is 28. She is currently taking labetalol. Her BP today is 110/74. Based on this information the midwife should

A) advise a 5-10% weight loss and a very low sodium diet, consult with OB for medication plan.
B) collaborate or refer to MD for medication, labs, and follow-up plans.
C) advise home BP monitoring and consult with MD if BPs are elevated.
D) continue the labetalol and increase the frequency of her prenatal visits.

A

B) collaborate or refer to MD for medication, labs, and follow-up plans.

409
Q

A 42-year-old G4P2012 at 15 weeks gestation reports substernal burning, nausea and vomiting. She has a history of chronic hypertension which has been controlled with antihypertensives for the past 2 years. Her baseline labs were all normal. Her BP today is 128/82. Urine protein is negative. Appropriate assessment (A) and management plan (P) are

A) A: superimposed preeclampsia; P: order complete blood count (CBC), complete metabolic panel (CMP), lactic acid dehydrogenase (LDH) and uric acid; collaborate with obstetrician.
B) A: preeclampsia; P: order complete blood count (CBC), complete metabolic panel (CMP), lactic acid dehydrogenase (LDH) and uric acid; consult with obstetrician.
C) A: Gastric reflux; P: encourage self-help measures and alternative oral anti-acids or ranitidine (Zantac) 75mg PO BID.
D) A: HELLP; P: order complete blood count (CBC), type and screen, complete metabolic panel (CMP), lactic acid dehydrogenase (LDH) and uric acid; refer to obstetrician.

A

C) A: Gastric reflux; P: encourage self-help measures and alternative oral anti-acids or ranitidine (Zantac) 75mg PO BID.

410
Q

A 28-year-old G1P0 at 40 weeks gestation presents in active labor. Her blood pressure upon admission is 148/88. Her urinalysis shows 1+ protein. The midwife’s priority action is to

A) collaborate for the administration of labetalol to control hypertension.
B) collaborate for the administration of magnesium sulfate for seizure prevention.
C) assess for symptoms of preeclampsia such as headache, visual changes, or abdominal pain.
D) provide routine labor management and support; she’s just in labor.

A

C) assess for symptoms of preeclampsia such as headache, visual changes, or abdominal pain.

411
Q

When working in a garden, a pregnant woman is most at risk for:

A) toxoplasmosis
B) cytomegalovirus (CMV).
C) listeriosis
D) human parvovirus B 19

A

A) toxoplasmosis

412
Q

A woman who has a urine culture indicating the presence of less than 100k colonies of GBS should be informed:

A) It is recommended that she receive antibiotics to treat her UTI
B) It is recommended that she receive a repeat urine culture in the third trimester to see if she still has GBS
C) It is recommended that she receive antibiotic prophylaxis in labor
D) It is recommended that she have a vaginal culture for GBS obtained between 35 and 37 weeks

A

C) It is recommended that she receive antibiotic prophylaxis in labor

413
Q

Which is a true statement regarding Hepatitis C in pregnancy?

A) Breastfeeding has been associated with mother-to-child transmission.
B) Women with hepatitis C should be offered a cesarean birth to reduce transmission
C) Routine screening of hepatitis C is recommended for pregnant women.
D) Prelabor rupture of membranes and the use of internal monitors may promote transmission.

A

D) Prelabor rupture of membranes and the use of internal monitors may promote transmission.

414
Q

Which of the following is appropriate to tell a pregnant woman who is HIV positive and has been stable with her infection for 5 years?

A) You should not breastfeed your baby.
B) You will need a monthly CD4 count during pregnancy.
C) Pregnancy will make the disease progress somewhat quicker.
D) Pregnancy will make the disease progress more slowly.

A

A) You should not breastfeed your baby.

415
Q

A G2P1001 reports during her 28 week gestation visit that her husband is returning from a trip to Brazil. Although he denies any Zika virus symptoms, she asks if there could be any risk to her pregnancy. The nurse-midwife explains

A) she needs to be tested for Zika virus infection with Zika virus IgM.
B) because of his possible exposure to the Zika virus they should abstain from vaginal, anal, or oral intercourse or correctly use condoms for the rest of the pregnancy.
C) there is no need to worry since pregnancy complications occur with exposure during the first trimester.
D) most people suffer from the typical Zika infection symptoms of fever, macular or papular rash, arthralgia, and conjunctivitis. Since her husband is asymptomatic it is unlikely he is infected.

A

B) because of his possible exposure to the Zika virus they should abstain from vaginal, anal, or oral intercourse or correctly use condoms for the rest of the pregnancy.

416
Q

A 23-year-old daycare worker at 22 weeks gestation reports swollen lymph nodes, fatigue and sore throat. Which infection should the provider suspect?

A) Toxoplasmosis
B) Varicella
C) Listeriosis
D) Cytomegalovirus

A

D) Cytomegalovirus

417
Q

During a prenatal physical exam genital warts are discovered. The nurse-midwife advises the woman

A) to stretch the perineal area that has warts.
B) that vaginal delivery is recommended.
C) that genital warts will decrease in size during pregnancy.
D) to treat with podophyllin to reduce warts.

A

B) that vaginal delivery is recommended.

418
Q

Which of the following is a correct management approach concerning bacterial vaginosis (BV) and pregnant women?

A) Test symptomatic women and treat positive results with oral metronidizole (Flagyl).
B) Obtain a fetal fibronectin every 2 weeks following a diagnosis of bacterial vaginosis (BV).
C) Screen all women for BV and treat positive results during the first trimester.
D) Screen all women for BV who are at risk for preterm birth.

A

A) Test symptomatic women and treat positive results with oral metronidizole (Flagyl).

419
Q

Which infection has the potential to cause fetal anemia, hydrops fetalis, or fetal death in a fetus if a woman is exposed to it during pregnancy?

A) Parvovirus B19
B) Cytomegalovirus
C) Toxoplasmosis
D) Listeriosis

A

A) Parvovirus B19

420
Q

If a woman contracts varicella infection 4 days prior to giving birth

A) her newborn needs to be given varicella-zoster immune globulin.
B) the fetus is at risk for congenital varicella syndrome.
C) she needs hospitalization and intravenous acyclovir.
D) she should have an operative birth.

A

A) her newborn needs to be given varicella-zoster immune globulin.

421
Q

An elective Cesarean delivery should be offered to a woman who is human immunodeficiency virus (HIV) positive in which situation?

A) Never.
B) If her membranes rupture prior to the onset of labor.
C) Based on the woman’s viral load.
D) In all situations.

A

C) Based on the woman’s viral load.

422
Q

Which of the following antibiotics or class of antibiotics is associated with fetal cardiovascular defects and/or oral cleft defects?

A) Tetracyclines
B) Sulfonamides
C) Cephalosporins
D) penicillins

A

B) Sulfonamides

Sulfonamides should be avoided in both the first and third trimesters unless no other reasonable alternative is available. The mechanism of action is inhibition of folate metabolism, which may lead to cardiovascular defects and oral cleft defects. lecture notes.

423
Q

Which of the following is the best statement to give pregnant women about toxoplasmosis?

A) It can cause preterm birth and is most often contracted through cat feces.
B) It can be prevented by avoiding cat litter boxes and soft cheeses while pregnant.
C) The most common symptom is arthralgia and treatment with antiretrovirals can reduce fetal transmission.
D) avoid eating uncooked or partially cooked meat during pregnancy.

A

D) avoid eating uncooked or partially cooked meat during pregnancy.

424
Q

A pregnant woman presents with a maculopapular rash, fever, malaise, sore throat, and lymphadenopathy. A fetus’s exposure to this condition may cause fetal deafness, cataracts, and cardiac defects. The most likely infection is

A) parvovirus B19.
B) toxoplasmosis.
C) listeriosis.
D) rubella.

A

D) rubella.

425
Q

While reviewing a pregnant woman’s social history at a new OB visit, the woman tells the provider that she was incarcerated for 6 months during the last year. Which of the following lab tests should be ordered based upon this history?

A) Hepatitis B Surface Antigen (HBsAG)
B) Rubella immunity status
C) Hepatitis C Surface Antigen (HCsAg)
D) Hepatitis A Surface Antigen (HBsAg)

A

C) Hepatitis C Surface Antigen (HCsAg)

426
Q

When treating pyelonephritis in the third trimester of pregnancy the midwife should

A) refer to an obstetrician for parenteral inpatient therapy.
B) consult with an obstetrician regarding outpatient therapy.
C) prescribe cephalexin (Keflex) 500 mg orally 4 times/day for 10-12 days.

A

A) refer to an obstetrician for parenteral inpatient therapy.

427
Q

Which is true regarding Cytomegalovirus (CMV) infection during pregnancy?

A) Women should be counseled to receive the Cytomegalovirus (CMV) vaccine prior to pregnancy.
B) With primary maternal Cytomegalovirus (CMV) infection, the risk of transmission to the fetus is less then 25%.
C) The most common mode of transmission of Cytomegalovirus (CMV) is the fecal-oral route.
D) The greatest risk to the fetus occurs with a primary infection during the first trimester or early second trimester.

A

D) The greatest risk to the fetus occurs with a primary infection during the first trimester or early second trimester.

428
Q

Toxoplasmosis infection in pregnancy

A) is often asymptomatic.
B) is diagnosed by blood culture.
C) causes greatest fetal effects after 20 weeks.
D) can be reduced by routine screening.

A

A) is often asymptomatic.

429
Q

A G1P0 at 8 weeks gestation informs the nurse-midwife that she and her husband recently returned from a trip to Mexico. Despite being asymptomatic, she is concerned about her risk for having contracted the Zika virus. The nurse-midwife explains, “The Centers for Disease Control and Prevention (CDC) recommend testing

A) for Zika IgG antibodies within a 4-16 week window after travel to a Zika outbreak area.”
B) if you develop Zika virus symptoms, including rapid onset of fever, maculopapular rash, arthralgia, or conjunctivitis, or the fetal ultrasound indicates a possible infection”
C) within 2 weeks of travel using Zika virus plaque reduction neutralization test (PRNT) and Zika IgM.”

D) for Zika virus nucleic acid test (NAT) on serum and urine and serum Zika IgM antibodies within a 12 week window after travel to a Zika outbreak area.”

A

B) if you develop Zika virus symptoms, including rapid onset of fever, maculopapular rash, arthralgia, or conjunctivitis, or the fetal ultrasound indicates a possible infection”

430
Q

Which is the BEST advice to give a pregnant woman to prevent toxoplasmosis?

A) Have your partner change the litter box for all cats, even strictly indoor cats.
B) Do not eat raw or undercooked meat.
C) Do not soft, unpasteurized cheeses.

A

B) Do not eat raw or undercooked meat.

431
Q

Which is accurate regarding genital herpes and pregnancy?

A) Vertical transmission occurs in 30% of women with secondary herpes outbreaks.
B) Prophylactic therapy prevents all neonatal transmission during birth.
C) A primary maternal herpes outbreak near the time of delivery carries the greatest risk of neonatal infection.
D) Prophylaxis to prevent recurrent outbreaks is best taken from 38 weeks to term.

A

C) A primary maternal herpes outbreak near the time of delivery carries the greatest risk of neonatal infection.

432
Q

Describe a currently accepted management approach for prevention of early-onset group B strep infection in newborns.

A) Treat women with a positive group B strep (GBS) culture from a previous pregnancy with antibiotics in labor.
B) Perform a recto-vaginal culture at the first prenatal visit and treat women with positive cultures with antibiotics during labor.
C) Pretreat women with a positive group B strep (GBS) culture with oral antibiotics prior to labor then treat all infants with antibiotics after birth.
D) Treat women with an unknown group B strep (GBS) status with antibiotics in labor if risk factors are present.

A

D) Treat women with an unknown group B strep (GBS) status with antibiotics in labor if risk factors are present.

433
Q

Which of the following illnesses should a pregnant woman working at a daycare be most concerned about contracting?

A) HIV
B) Hepatitis C
C) Hepatitis A
D) Hepatitis B

A

C) Hepatitis A

434
Q

During the prenatal interview a G1P0 tells the nurse-midwife that she has not had chicken pox nor has she been given the vaccine. The midwife’s plans include ordering a varicella serology and if results are

A) IgG positive counseling to avoid exposure during pregnancy.
B) IgG negative ordering the varcella vaccine, Varivax.
C) IgG negative counseling to avoid exposure during pregnancy.
D) IgM negative ordering the varicella vaccine, Varivax.

A

C) IgG negative counseling to avoid exposure during pregnancy.

435
Q

A pregnant woman has condylomata acuminata. Which is appropriate pharmacologic management?

A) benzathine penicillin, 3 injections once weekly for 3 weeks
B) oral azithromycin for one week
C) topical treatment with trichloroacetic acid.
D) antiretroviral therapy to minimize fetal exposure

A

C) topical treatment with trichloroacetic acid.

436
Q

Which of the following women is most likely to transmit Hepatitis B to her fetus?

A) A woman who is hepatitis B surface antigen (HBsAg) positive and Hepatitis B e-antigen (HBeAg) negative
B) A woman who is hepatitis B surface antigen (HBsAg) positive and Hepatitis B e-antigen (HBeAg) positive
C) A woman who is hepatitis A surface antigen (HAsAg) positive
D) A woman who is hepatitis B surface antibody (HBsAb) positive

A

B) A woman who is hepatitis B surface antigen (HBsAg) positive and Hepatitis B e-antigen (HBeAg) positive

437
Q

Which of the following is a true statement about cytomegalovirus (CMV) infection in pregnancy?

A) most pregnant women are not immune to CMV.
B) a high fever characteristic of CMV is the cause of fetal effects.
C) the fetus is at greatest risk with a primary maternal infection.
D) CMV is highly contagious by airborne droplet.

A

C) the fetus is at greatest risk with a primary maternal infection.

438
Q

When counseling a woman during her initial prenatal appointment on avoiding listeriosis the nurse-midwife encourages her to avoid

A) eating meat cooked to well done.
B) changing the cat’s litterbox.
C) eating soft cheeses, like Brie, Feta, or Queso Fresco.
D) eating hot dogs cooked till steaming hot.

A

C) eating soft cheeses, like Brie, Feta, or Queso Fresco.

439
Q

When providing education on how to avoid listeriosis in pregnancy, the midwife should advise the woman to

A) wash hands carefully after interacting with young children.
B) avoid processed foods such as pate, hummus, wieners, and sliced deli meats.
C) wear gloves when gardening or changing the litter box.
D) avoid consuming raw or undercooked meats.

A

B) avoid processed foods such as pate, hummus, wieners, and sliced deli meats.

440
Q

Mother-infant transmission (vertical transmission) of Hepatitis B (HBV) occurs when the mother becomes infected during which trimester of pregnancy?

A

Third Trimester

441
Q

Which statment is true about hepatitis B and pregnancy?

A) Operative birth is highly beneficial in preventing neonatal hepatitis B transmission.
B) HBV vaccination is not necessary when the neonate receives hepatitis B immunoglobulin (HBIG).
C) Breastfeeding is contraindicated even if the infant gets hepatitis B immunoglobulin.
D) Hepatitis B immunoglobulin (HBIG) can reduce neonatal transmission by more than 90%.

A

D) Hepatitis B immunoglobulin (HBIG) can reduce neonatal transmission by more than 90%.

442
Q

Which statement is appropriate to counsel a woman whose urine culture at 14 weeks gestation was positive for Group B Strep (GBS) with a colony count of 100,000 CFU/mL?

A) “I’d like to initiate antibiotic suppressive therapy for Group B Strep (GBS).”
B) “Approximately 8-12% of all women have Group B Strep (GBS) bacteriuria.”
C) “I will treat you now and then do a repeat culture at 36 weeks”
D) “It’s best to treat you now and again in labor.”

A

D) “It’s best to treat you now and again in labor.”

443
Q

Which of the following women is most likely to vertically transmit her illness to her baby?

A) A woman who is HBsAg positive, e-antigen positive
B) A woman who tests positive for Hepatitis C antibodies
C) A woman who screens positive for IgM anti-HAV antibodies
D) A woman who is HBsAg positive, e-antigen negative

A

A) A woman who is HBsAg positive, e-antigen positive

444
Q

A pregnant woman at 10 weeks gestation has been exposed to chickenpox. Which is the appropriate next step?

A) Offer her the varicella vaccine to protect her fetus.
B) Inform her that chickenpox is very contagious and that she may need additional lab testing.
C) Ask her to come to the office if lesions appear on her body.
D) Reassure her that chickenpox is not usually problematic in early pregnancy.

A

B) Inform her that chickenpox is very contagious and that she may need additional lab testing.

445
Q

When counseling on precautions for cytomegalovirus (CMV) prevention the midwife encourages the woman to

A) avoid sharing drinking glasses or eating utensils with young children.
B) determine cytomegalovirus (CMV) immunity by ordering an IgG serology.
C) receive a cytomegalovirus (CMV) vaccine preconceptually.

A

A) avoid sharing drinking glasses or eating utensils with young children.

446
Q

Pregnant women with human immunodeficiency virus (HIV) should be informed that

A) breastfeeding is recommended if the CD4 cell counts are low.
B) diagnosis and treatment of human immunodeficiency virus (HIV) is within independent midwifery scope of practice.
C) breastfeeding is contraindicated where safe breast milk substitutes are available.
D) a vaginal birth is contraindicated for all pregnant women with human immunodeficiency virus (HIV).

A

C) breastfeeding is contraindicated where safe breast milk substitutes are available.

447
Q

At 22 weeks gestation a G3P2002 has a urine culture that is positive for group B Streptococcus (GBS). The nurse-midwife explains

A) “A group B Streptococcus (GBS) urinary tract infection (UTI) infection indicates heavy vaginal colonization. You will need to be treated for the urinary tract infection (UTI) with antibiotics now. During labor you will be given antibiotics for the vaginal colonization.”
B) “ Since group B Streptococcus (GBS) is a transient microbe you will need antibiotic treatment now and a vaginal/rectal culture at 35-37 weeks gestation to determine if need treatment during labor.”
C) “A urinary tract infection (UTI) with group B Streptococcus (GBS) means that you are a chronic carrier and will need antibiotic treatment during labor and any future labors.”
D) “A group B Streptococcus(GBS) urinary tract infection (UTI) infection indicates heavy vaginal colonization. You will need to be treated for the urinary tract infection (UTI) with antibiotics now and maintained on a prophylactic dosage for the rest of your pregnancy.”

A

A) “A group B Streptococcus (GBS) urinary tract infection (UTI) infection indicates heavy vaginal colonization. You will need to be treated for the urinary tract infection (UTI) with antibiotics now. During labor you will be given antibiotics for the vaginal colonization.”

448
Q

Which of the following is an accurate statement regarding human papilloma virus (HPV) in pregnancy?

A) Podophyllin can be used in pregnancy to eradicate warts.
B) Treatment of HPV in pregnancy should be aggressive.
C) Use condoms during pregnancy to avoid reinfection.
D) Genital warts can grow larger during pregnancy.

A

D) Genital warts can grow larger during pregnancy.

449
Q

Which of the following is a correct statment about Hepatitis B in pregnancy?

A) IV drug users are more at risk and operative birth increases risk of fetal transmission
B) The incubation period is 1-4 months and has a rate of horizontal fetal transmission of about 35%
C) The risk of fetal infection is approximately 90% during birth and giving hepatitis B immunoglogulin (HBIG) after birth reduces that risk to 3%.
D) Presence of anti-HBs means life long immunity and women with active infection should not breastfeed

A

C) The risk of fetal infection is approximately 90% during birth and giving hepatitis B immunoglogulin (HBIG) after birth reduces that risk to 3%.

Yes, the rate of fetal transmission in a Hep B positive mother during birth (not prenatally) is about 90%. Giving hepatitis immune globulin reduces fetal infection to 3%. Important point to tell Hep B positive pregnant women!

450
Q

A G2P1001 at 28 weeks gestation was recently exposed to parvovirus B19. Her serology blood work reveals IgG -, IgM +. The nurse-midwife counsels her

A) “You have an active case of parvovirus B19. The risk of fetal transmission is 30%-50%. The risk of a fetal complication from the virus is about 10%. The greatest risk to the fetus is felt to occur when parvovirus B19 infection occurs before 22 weeks of pregnancy.”
B) “You are non-immune to parvovirus B19 and currently show no signs of infection. We will need to redraw the serology in 2 weeks to ensure that you do not develop an active infection.”
C) “You are immune to parvovirus B19. There is no risk for fetal infection.”

A

A) “You have an active case of parvovirus B19. The risk of fetal transmission is 30%-50%. The risk of a fetal complication from the virus is about 10%. The greatest risk to the fetus is felt to occur when parvovirus B19 infection occurs before 22 weeks of pregnancy.”

451
Q

A 34-year-old G3P2 arrives for an initial prenatal visit at 10 weeks gestation. She had a positive culture for group B strep (GBS) during her last pregnancy. What is the recommended plan for the current pregnancy, based on the Center for Disease Control and Prevention (CDC) guidelines?

A) Antibiotic prophylaxis during labor, no culture needed.
B) Recto-vaginal culture at 35-37 weeks, need for antibiotic prophylaxis in labor based on results.
C) Antibiotic prophylaxis during labor if risk factors are present.
D) Recto-vaginal culture today, need for antibiotic prophylaxis based on these results.

A

B) Recto-vaginal culture at 35-37 weeks, need for antibiotic prophylaxis in labor based on results.

452
Q

Per the Centers for Disease Control and Prevention (CDC), which is an appropriate management decision for a CNM/WHNP caring for a pregnant woman whose first child was ill with Group B strep (GBS) sepsis?

A) Refer her to an obstetrician for the remainder of her care.
B) Do not collect a Group B strep (GBS) culture during pregnancy.
C) Obtain a Group B strep (GBS) culture at first prenatal visit.
D) Treat with antibiotics now and when she is in labor.

A

B) Do not collect a Group B strep (GBS) culture during pregnancy.

453
Q

A woman at 18 weeks gestation reports that her son’s daycare facility had an outbreak of Fifth’s disease. What should the midwife do?

A) Inform the woman that fetuses are rarely affected at this gestation.
B) Reassure the woman that if her son is not sick, she is not in danger.
C) Obtain a serum B 19 qualitative titer today and tomorrow.
D) Obtain a serum parvovirus IgM and IgG today.

A

D) Obtain a serum parvovirus IgM and IgG today.

454
Q

SATA: Oligohydramnios is associated with:
A) postmaturity syndrome.
B) fetal growth restriction.
C) substance abuse
D) maternal bacterial infection.
E) uteroplacental insufficiency.
F) gestational diabetes.
G) cord compression.
H) Rh isoimmunization.
I) dehydration.

A

A) postmaturity syndrome.
B) fetal growth restriction.
E) uteroplacental insufficiency.
G) cord compression.
H) Rh isoimmunization.
I) dehydration.

455
Q

Maternal thyroxine (T4) is important for fetal brain development

A) until around 12 weeks when fetal production of thyroxine (T4) begins.
B) up to 28 weeks when fetal production of thyroxine (T4) reaches adult levels.
C) throughout the entire pregnancy.

A

C) throughout the entire pregnancy.

456
Q

During the physical exam of a 32 year-old G4P2013 10 week gestation, a slight enlargement of a smooth thyroid is noted. Upon questioning she admits to feeling fatigued and constipated but denies cold or heat intolerance, muscle cramps, unusual weight gain, hair loss, or palpitations. An appropriate assessment (A) and management plan (P) includes

A) A: Hashimoto thyroiditis; P: order thyroid stimulating hormone (TSH) and free T 3.
B) A: subclinical hypothyroidism; P: order thyroid stimulating hormone (TSH) and free T4.
C) A: normal thyroid variation; thyroid disorder risk factors ; P: order thyroid stimulating hormone (TSH).
D) A: Graves disease; P: order thyroid stimulating hormone (TSH) and total T3 and T4.

A

C) A: normal thyroid variation; thyroid disorder risk factors ; P: order thyroid stimulating hormone (TSH).

457
Q

Changes in thyroid hormone levels during pregnancy include

A) increased amounts of serum thyroid hormone binding proteins causing free T4 and T3 to be elevated.
B) decreased total T3 and T4 levels in response to elevated estrogen levels.
C) decreasing thyroid stimulating hormone (TSH) levels during the first trimester when human chorionic gonadotrophin (HCG) levels are high.
D) thyroid stimulating hormone (TSH) levels remaining the same throughout pregnancy.

A

C) decreasing thyroid stimulating hormone (TSH) levels during the first trimester when human chorionic gonadotrophin (HCG) levels are high.

458
Q

A G2P1 at 15 weeks gestation is complaining of new onset insomnia, palpitations, excessive sweating, and weight loss. Physical exam reveals an enlarged, soft thyroid without nodules. Appropriate assessment (A) and management plan (P) would include

A) A: Hyperthyroidism; P: order thyroid stimulating hormone (TSH) and total T4.
B) A: Hypothyroidism; P: order total T4 and T3.
C) A: Hyperthyroidism; P: order thyroid stimulating hormone (TSH) and free T4.
D) A: Anemia; P: order complete blood count (CBC).

A

C) A: Hyperthyroidism; P: order thyroid stimulating hormone (TSH) and free T4.

459
Q

Pregnant women abusing substances may be more willing to disclose their substance use if

A) if they are randomly screened using a screening tool like CAGE.
B) use is detected with a covert urine drug screen.
C) they are routinely screened using a screening tool like Audit-C.

A

C) they are routinely screened using a screening tool like Audit-C.

460
Q

A G1P0 at 34 weeks gestation fundal height measures 31 centimeters. At her last visit, 2 weeks ago, she measured 30 centimeters. An appropriate assessment (A) and management plan (P) includes

A) A: size less than dates; P: consult with a physician.
B) A: size equals dates; P: provide reassurance that fetal growth is within normal limits.
C) A: size less than dates; P: schedule biweekly fetal surveillance testing.
D) A: size less than dates; P: order an ultrasound.

A

D) A: size less than dates; P: order an ultrasound.

yes, you want to first diagnose any growth restriction prior to surveillance or referral

461
Q

A 23 year old G2P0101 at 25 weeks gestation complains of burning on urination, increased frequency, and urgency. Her physical exam reveals

T 98.2 ° F, P 72, R 18,BP 110/66

mild suprapubic tenderness

negative costovertebral tenderness

An appropriate assessment (A) and management plan (P) includes

A) A: cystitis; P: order urinalysis (UA), urine culture, and treat empirically.
B) A: asymptomatic bacturia (ASB); P: order urinalysis (UA) and urine culture. Wait for culture results before treating.
C) A: pyelonephritis; P: order complete blood count (CBC), urinalysis (UA) and urine culture. Refer to obstetrician.

A

A) A: cystitis; P: order urinalysis (UA), urine culture, and treat empirically.

462
Q

Asymptomatic urinary tract infections in pregnancy are associated with

A) placental abruption.
B) preeclampsia.
C) pyelonephritis.
D) preterm prelabor rupture of membranes.

A

C) pyelonephritis.

463
Q

The CNM/WHNP is reviewing initial prenatal labs for a woman who is 10 weeks pregnant. The results are:
Blood type: O negative
Antibody screen: negative
H&H: 11/35
Chlamydia and Gonorrhea: both negative
Urine culture: 10,000 colonies of Group B Strep
HBsAg- negative
RPR: nonreactive
Which is the best interpretation of these lab results?

A) A Rhogam injection should be offered at her next office visit.
B) Intrapartum prophylaxis for Group B Strep is indicated.
C) These results are normal and don’t require any follow-up.
D) Antibiotic treatment is indicated for her UTI.

A

B) Intrapartum prophylaxis for Group B Strep is indicated.

464
Q

Asymptomatic bacteruria in pregnancy:

A) occurs in about 20% of pregnancies.
B) carries the same risk for pyelonephritis as in non-pregnant women.
C) should be treated if the colony count is > 10,000.
D) is most commonly caused by Eschericia coli.

A

D) is most commonly caused by Eschericia coli.

465
Q

A pregnant woman has condylomata acuminata. Which is appropriate pharmacologic management?

A) benzathine penicillin, 3 injections once weekly for 3 weeks
B) oral azithromycin for one week
C) antiretroviral therapy to minimize fetal exposure
D) topical treatment with trichloroacetic acid.

A

D) topical treatment with trichloroacetic acid.

466
Q

A 32-year-old G6P4103 presents for a routine visit at 34 weeks gestation. They had a cesarean section with their last pregnancy. Their BMI is 29.2. A marginal placenta previa was diagnosed at 32 weeks gestation after an episode of vaginal bleeding. Which of the following is the primary risk factor for placenta previa for this person?

A) prior cesarean section
B) body mass index
C) age
D) parity

A

A) prior cesarean section

The primary risk factor for development of placenta previa is previous uterine scarring secondary to cesarean section or uterine surgery.

467
Q

Which statement is true regarding safe, effective treatment of type 2 diabetes in pregnancy?

A) A diabetic diet and regular exercise may render pharmacologic treatment unnecessary.
B) Insulin is required to treat T2DM in pregnancy
C) The sulfonylurea glyburide is contraindicated in pregnancy.
D) Medication is always required.

A

A) A diabetic diet and regular exercise may render pharmacologic treatment unnecessary.

468
Q

A G3P2002 at 32 weeks gestation has a known placenta previa. She had a recent significant bleed but the bleeding has now stopped. She has two small children at home. The most evidence-based recommendation for her care is

A) admit to the hospital for bed rest.
B) delivery now to avoid further fetal compromise.
C) magnesium sulfate to decrease the risk of bleeding.
D) corticosteroids to increase fetal lung maturation.

A

D) corticosteroids to increase fetal lung maturation.

469
Q

Low amniotic fluid volume is associated with all of the following EXCEPT:

A) Fetal lung abnormalities
B) Fetal hypoxia
C) Uteroplacental insufficiency
D) Unstable lie

A

D) Unstable lie

470
Q

A 28-year-old G4P2102 at 37 weeks gestation reports constant abdominal pain, contractions, and decreased fetal movement over the last 2 hours. She denies vaginal bleeding or leaking of fluid. Her vital signs on admission are Pulse 135, Respiration 24, Blood Pressure 90/50. Cervical Exam 3 cm/ 90%/ vertex/ -1. Fetal heart tones are a category 2: baseline170 bpm, minimal variability, and repetitive late decelerations. A correct assessment (A) and plan (P) include

A) A: Hemodynamically unstable; P: start fluid resuscitation stat and oxygen via face mask, continuous fetal monitoring, and refer care to a physician.
B) A: Early labor; P: transfer to labor and delivery.
C) A: Abdominal pain; P: order labs and a stat ultrasound to rule out appendicitis, refer to surgeon.
D) A: Tachysystole; P: order subcutaneous terbutaline and consult with obstetrician.

A

A) A: Hemodynamically unstable; P: start fluid resuscitation stat and oxygen via face mask, continuous fetal monitoring, and refer care to a physician.

471
Q

SATA: A G2P0010 at 39 weeks gestation is 5cm/100%/vertex/-1 after a 30 hour oxytocin induction. Her membranes were artificially ruptured 18 hours ago. Shortly after receiving an epidural an intrauterine pressure catheter (IUPC) and internal scalp electrode (ISE) were placed resulting in 8 vaginal examinations since admission. Choose those factors that increase her risk for intra-amniotic infection.

A) epidural
B) prolonged labor
C) >4 vaginal exams
D) multiparous
E) prolonged rupture of membranes
F) oxytocin
G) IUPC and ISE

A

B) prolonged labor
C) >4 vaginal exams
E) prolonged rupture of membranes
G) IUPC and ISE

472
Q

An intrauterine fetal demise (IUFD) is unexpectedly discovered during a 40 week visit. The woman is in shock and asks to go home and consider her options. The nurse-midwife advises her

A) the specific cause of death is found in over 80% of fetal deaths.
B) to safely allow for expectant management, coagulation studies will need to be done.
C) the best option is to go directly to the hospital for induction of labor.
D) to improve the likelihood of determining the cause of death a cesarean delivery is recommended.

A

B) to safely allow for expectant management, coagulation studies will need to be done.

473
Q

A risk factor for placental abruption is:

A) low maternal weight
B) advanced maternal age
C) conception while taking progestin-only pills
D) Rh negative blood type

A

B) advanced maternal age

474
Q

A 32 year old G6P4103 presents for a routine visit at 34 weeks gestation. She had a cesarean section with her last pregnancy. Her BMI is 29.2. A marginal placenta previa was diagnosed at 32 weeks gestation after an episode of vaginal bleeding. Which of the following is a risk factor for placenta previa for this woman?

A) age
B) body mass index
C) prior cesarean section

A

C) prior cesarean section

475
Q

A 39-year-old at 34 weeks reports the sudden onset of left leg pain, swelling, and stiffness. Based on the phone interview the midwife suspects a deep vein thrombosis (DVT). The midwife should

A) evaluate her in OB triage, order compression ultrasonography and then consult with an obstetrician.
B) evaluate her in the office, confirm diagnosis using Homan’s sign, and then refer to the obstetrician.
C) order D-dimer testing and then consult with an obstetrician.
D) send her to the hospital for a Ventilation/Perfusion (VQ) scan and then refer to the obstetrician for heparin therapy.

A

A) evaluate her in OB triage, order compression ultrasonography and then consult with an obstetrician.

476
Q

A woman at 39 weeks’ gestation has been brought to the obstetrical triage unit after a minor motor vehicle accident. Which would be an indication for the midwife to refer?

A) Bruising on face and abdomen; ultrasound negative for placenta abruption; uterine irritability with abdominal tenderness; category II tracing
B) Multiple abrasions on face, hands and legs; abdomen soft, non-tender; category I tracing, Rh negative blood type
C) No abdominal tenderness; mild contractions every 5 minutes; 2 cm/80% effaced/-1; HCT 32.8%; Kleihaur-Betke <5 (normal), category I tracing

A

A) Bruising on face and abdomen; ultrasound negative for placenta abruption; uterine irritability with abdominal tenderness; category II tracing

477
Q

A G1P0 at 42 weeks is scheduled for postterm induction of labor. Her cervical exam is 1 cm/50%/soft/posterior/-2 with a bishop score of 4. The nurse-midwife explains cervical ripening options including

A) oxytocin is the most effective agent for cervical ripening.
B) prostaglandins have little effect on the cervix.
C) mechanical and pharmacological methods are not able to be used together.
D) mechanical methods dilate and soften the cervix.

A

D) mechanical methods dilate and soften the cervix.

478
Q

Which woman is the best candidate for external cephalic version?

A) 38 weeks gestation, +1 station, right sacrum posterior (RSP) position.
B) 38 weeks gestation, -2 station, right sacrum anterior (RSA) position.
C) 35 weeks gestation, -1 station, right sacrum transverse (RST) position

A

B) 38 weeks gestation, -2 station, right sacrum anterior (RSA) position.

479
Q

A woman at 7 weeks gestation presents to clinic reporting “constant vomiting”. She has been unable to work due to these symptoms. Her urine dip shows the following: Specific gravity: 1.030 with negative nitrites, trace leukocytes, large ketones and 1+ protein. Her pre-pregnancy weight was 165 pounds and her weight today is 156 pounds. Which of the following is the best next step in the plan of care for this woman?

A) Call her insurance company to see if Diclegis is covered on her plan.
B) Suggest she go to the hospital now for evaluation and treatment.
C) Reassure her that she is likely to feel better when she approaches 14 weeks gestation.
D) Suggest she begin taking Zofran 4mg PO every 4 hours as needed.

A

B) Suggest she go to the hospital now for evaluation and treatment.

480
Q

A 38 year old G3P1011 is at 38 weeks gestation. Her BMI is 18.8 and she has gained 24 lbs. She was diagnosed with mild preeclampsia last week. As you get her ready for her non-stress test (NST) today, she says she has a mild backache, and she starts to have some bleeding that is running down her leg. The most important action for the clinician to take first is:

A) obtain a CBC
B) palpate her abdomen
C) do a stat vaginal exam
D) take her blood pressure

A

B) palpate her abdomen

yes, you want a diagnosis and this will lead you to abruption vs previa. Other staff can take other actions.

481
Q

A biophysical profile (BPP) for decreased fetal movement at 32 weeks gestation reveals an amniotic fluid index (AFI) of 5 centimeters. The nurse-midwife is aware that this finding may be related to

A) esophageal atresia and may cause difficulty palpating fetal parts.
B) gestational diabetes and may decrease the risk of meconium aspiration syndrome (MAS).
C) placental insufficiency and increases the risk of variable fetal heart rate decelerations.

A

C) placental insufficiency and increases the risk of variable fetal heart rate decelerations.

482
Q

Which of the following statements about prenatal risk assessment is accurate?

A) Prenatal risk assessment increases adverse pregnancy outcomes.
B) Prenatal risk assessment prevents adverse pregnancy outcomes.
C) Prenatal risk assessment accurately predicts adverse pregnancy outcomes.
D) Prenatal risk assessment identifies the statistical probability of an adverse pregnancy outcome.

A

D) Prenatal risk assessment identifies the statistical probability of an adverse pregnancy outcome.

483
Q

A placenta previa is noted on the 20 week ultrasound of an asymptomatic G5P3103. An appropriate management plan includes

A) Cervical exam, advise bedrest, repeat scan at 24 weeks gestation.
B) Advise pelvic rest for the pregnancy, plan scheduled cesarean delivery.
C) Advise bedrest, repeat scan at 32 weeks gestation.
D) Advise pelvic rest, call with vaginal bleeding, repeat scan at 28 weeks gestation.

A

D) Advise pelvic rest, call with vaginal bleeding, repeat scan at 28 weeks gestation.

484
Q

A 24 yo G7P4115 at 12 weeks gestation reports nausea and vomiting 3-4 times per day for the past week. On examination she is found to have a slightly and diffusely enlarged thyroid without nodules. Appropriate assessment (A) and management plan (P) include

A) A: hyperthyroidism; P: refer to an endocrinologist
B) A: hypothyroidism; P: check thyroid stimulating hormone (TSH)
C) A: hyperemesis; P: check ketones and weight

A

C) A: hyperemesis; P: check ketones and weight

485
Q

When blood vessels run from the umbilical cord between the amnion and chorion through the membranes to the placenta, it is called:

A) Marginal Placenta
B) Succenturiate lobe
C) Velamentous cord insertion
D) Vasa previa

A

C) Velamentous cord insertion

486
Q

Appropriate management of placental abruption

A) is based primarily on ultrasound findings.
B) depends on the degree of abruption.
C) includes amnioinfusion for fetal heart rate abnormalities.
D) is always an emergency cesarean section.

A

B) depends on the degree of abruption.

487
Q

A woman at 39 weeks’ gestation has been brought to the obstetrical triage unit after a minor motor vehicle accident. Which would be an indication for the midwife to refer?

A) No abdominal tenderness; mild contractions every 5 minutes; 2 cm/80% effaced/-1; HCT 32.8%; Kleihaur-Betke <5 (normal), category I tracing
B) Bruising on face and abdomen; ultrasound negative for placenta abruption; uterine irritability with abdominal tenderness; category II tracing
C) Multiple abrasions on face, hands and legs; abdomen soft, non-tender; category I tracing, Rh negative blood type

A

B) Bruising on face and abdomen; ultrasound negative for placenta abruption; uterine irritability with abdominal tenderness; category II tracing

488
Q

When compared to obese pregnant women who have not had weight loss surgery, women pregnant after gastric bypass surgery:

A) Experience less favorable neonatal outcomes
B) Have a higher incidence of gestational diabetes and pregnancy-induced hypertension
C) Experience more pregnancy-related weight gain
D) More often need iron and Vitamin B12 supplementation

A

D) More often need iron and Vitamin B12 supplementation

489
Q

A 22 year old G2P1001 smoker at 38 weeks comes in for antenatal surveillance. Her nonstress test is equivocal; BPP 6/8 (2 off for fluid); AFI 4.8. Her cervical exam is 1cm/80%/posterior with a ballotable head. Which of the following is the most appropriate management plan?

A) Discuss with consulting physician and initiate induction immediately.
B) Repeat a biophysical profile in 24 hours.
C) Send her home with strict fetal movement counting instructions.
D) Repeat the NST after she hasn’t smoked for at least 30 minutes.

A

A) Discuss with consulting physician and initiate induction immediately.

490
Q

SATA: Leopold maneuvers discover an unengaged breech presentation at 37 weeks gestation in a G3P2002. An ultrasound confirms a breech presentation with an amniotic fluid index (AFI) of 12, estimated fetal weight (EFW) 6 lb 10 oz (3000 g) and an anterior, fundal placenta. The woman’s BMI is 28. Choose those factors that increase the likelihood of a successful external cephalic version.

A) estimated fetal weight 6 lbs 5 oz
B) BMI 28
C) amniotic fluid index of 12
D) multiparous
E) anterior, fundal placenta
F) unengaged breech

A

A) estimated fetal weight 6 lbs 5 oz
C) amniotic fluid index of 12
D) multiparous
F) unengaged breech

491
Q

Which diagnosis is most strongly associated with placental abruption?

A) Gestational diabetes
B) Preeclampsia
C) Oligohydramnios
D) Gestational thrombocytopenia

A

B) Preeclampsia

492
Q

A risk factor for placenta previa is

A) uterine scar.
B) maternal hypertensive disorder.
C) uterine leiomyoma.
D) poor nutritional status.

A

A) uterine scar.

493
Q

A woman at 34 weeks gestation is visiting from another state and has no prenatal records. She is experiencing vaginal bleeding. What should the midwife do first?

A) order an abdominal ultrasound.
B) determine blood type in case the woman needs RhoGAM.
C) immediately refer the woman to a physician.
D) perform a vaginal exam to rule out preterm labor.

A

A) order an abdominal ultrasound.

494
Q

SATA: A 36 year old G3P2002 arrives in the labor and delivery unit at 35 weeks gestation complaining of lower abdominal cramping, back discomfort, and moderate vaginal bleeding. Review of her prenatal record reveals that she smokes 1/2 ppd, body mass index (BMI) 20 with 20 lb weight gain. Her pregnancy has been complicated with fetal growth restriction. Placental placement is posterior. BP 150/90, P 90, R 18, T 98.6 F. On exam her uterus is mildly tender to palpation with regular uterine contractions. Cervical exam 1 cm/50%/vtx/-3/soft/anterior, membranes intact. Fetal heart tones 140’s, minimal variability, no decelerations, category 2. The nurse-midwife is suspicious of a partial abruption. What risk factors and symptoms would support this diagnosis?

A) back discomfort
B) cervical exam
C) smoker
D) uterine tenderness
E) posterior placenta
F) intact membranes
G) vaginal bleeding
H) fetal growth restriction
I) low body mass index and weight gain
J) hypertension
K) advanced maternal age

A

A) back discomfort
C) smoker
D) uterine tenderness
G) vaginal bleeding
H) fetal growth restriction
J) hypertension
K) advanced maternal age

495
Q

Of the following medications, which is the LEAST preferable over-the-counter (OTC) medication to recommend to pregnant women?
A) Tylenol Cold Multi-Symptom (acetaminophen, dextromethorphan & phenylephrine)
B) Tylenol (Acetaminophen)
C) Claritin (Loratadine)
D) Benadryl (Diphenhydramine)

A

A) Tylenol Cold Multi-Symptom (acetaminophen, dextromethorphan & phenylephrine)

496
Q

A pregnant woman arrives to clinic reporting acid reflux. Which of the following over-the-counter (OTC) medications would be your first-line treatment recommendation?

A) calcium carbonate (Tums)
B) metoclopramide (Reglan)
C) famotidine (Pepcid)
D) esomeprazole (Nexium)

A

A) calcium carbonate (Tums)

497
Q

A woman at 7 weeks gestation with a cold has tried non-pharmacologic remedies with no relief. She asks you for your recommendation on over-the-counter medications. Which of the following is an accurate statement to tell her?

A) “Guaifenesin, a cough suppressant, is safe to take in the first trimester.”
B) “Do not take first generation anti-histamines since they can be sedating.”
C) “Pseudoephedrine (Sudafed), a decongestant, is safe to take in the first trimester.”
D) “Use saline nasal spray and Tylenol as needed.”

A

D) “Use saline nasal spray and Tylenol as needed.”

498
Q

For a medication to be designated a teratogen, which criteria must be met?

A) It must act only during a specific window of vulnerability (for example, during organogenesis)
B) The incidence of malformations should decrease with increasing dosage and duration of exposure.
C) Both answers in this set are correct.

A

A) It must act only during a specific window of vulnerability (for example, during organogenesis)

The incidence of malformations should INCREASE with increasing dosage and duration of exposure.

499
Q

The period during which there is the highest risk of teratogen-induced gross malformations is:

A) immediately preconception.
B) 1-2 weeks after conception.
C) 3-8 weeks after conception.
D) 20-24 weeks after conception.

A

C) 3-8 weeks after conception.

500
Q

A 19-year-old client at 30 weeks in her pregnancy reports that she has headache, malaise, myalgia, fatigue, a temperature of 101*F, and chills that began last evening. She has never had flu immunization.
Which of the following medications would be indicated for her condition?

A) Tamiflu 75 mg orally twice daily
B) Zithromax 250 mg two now and one daily for the next 4 days
C) Pen VK 250 mg po QID for 10 days
D) Rest, ibuprofen, pseudoephedrine 240 mg orally twice daily.

A

A) Tamiflu 75 mg orally twice daily

501
Q

A 25 year old G2P1001 at 10 weeks gestation has a history of mild persistent asthma controlled with a beta agonist (albuterol) inhaler and inhaled corticosteroid (pulmicort). She is worried about the potential effects of the medication on her pregnancy. The nurse-midwife explains

A) the risks of uncontrolled asthma are greater than the risks of the medications.
B) beta agonists are associated with adverse perinatal outcomes like fetal growth restriction (FGR)
C) inhaled corticosteroids increase the risk of major congenital malformations.

A

A) the risks of uncontrolled asthma are greater than the risks of the medications.

502
Q

Changes required by the new FDA Pregnancy and Lactation Labeling Rule include:

A) adding information about risk summary, clinical considerations, and data to the pregnancy subsection.
B) adding additional safety information to the current ABCDX system.
C) replacing the lactation subsection with information for females and males of reproductive potential.
D) removing teratogenic medications from pharmacies so these drugs are not available to pregnant women.

A

A) adding information about risk summary, clinical considerations, and data to the pregnancy subsection.

503
Q

A woman whose last menstrual period was 4 weeks ago reports a positive pregnancy test. She has a history of epilepsy and has been taking Dilantin for years. Her last seizure was 10 years ago. What is the daily recommended dose of folic acid?

A) 0.4 mg
B) 0.8 mg
C) 1.4 mg
D) 4.0 mg

A

D) 4.0 mg

504
Q

Which class of antihypertensive medications listed below is considered safest in pregnancy?

A) Angiotensin Converting Enzyme Inhibitors (ACE Inhibitors)
B) Angiotensin Receptor Blockers (ARBs)
C) Calcium Channel Blockers (CCB)

A

C) Calcium Channel Blockers (CCB)

505
Q

A pregnant woman is 36 weeks gestation and has a cold. Her primary symptoms are congestion, cough, and headache and she does not feel well. The most appropriate advice to give her is:

A) she may take guaifenesin, diphenhydramine, and ibuprofen as needed.
B) she should avoid all over the counter medications during the last trimester of pregnancy.
C) she may use slippery elm bark for congestion with tea and honey for her cough.
D) she may take chlorpheniramine, pseudoephedrine, and acetaminophen as needed

A

D) she may take chlorpheniramine, pseudoephedrine, and acetaminophen as needed

506
Q

A pregnant person at 37 weeks gestation reports dysuria. Her urine culture is positive for E. Coli > 100,000 cfu/ml. Which medication is contraindicated for her?

A) Amoxicillin
B) Cephalexin (Keflex)
C) Ciprofloxacin (Cipro)
D) Trimethoprim/sulfamethoxazole (Bactrim DS)

A

D) Trimethoprim/sulfamethoxazole (Bactrim DS)

507
Q

Beta blockers should be avoided in patients with:

A) Severe kidney disease
B) Alcohol use disorder
C) Persistent asthma

A

C) Persistent asthma

508
Q

A 23 year old G1P0 is at clinic for her first visit at 7 weeks gestation with an unplanned pregnancy. She has acne and is taking Acutane. Your BEST plan of action is to:

A) obtain serum genetic testing
B) advise her to stop taking Acutane now
C) order an immediate ultrasound for anomaly screening
D) reassure her that fetal effects are rare with limited exposure

A

B) advise her to stop taking Acutane now

509
Q

Which of the following medications has been associated with gastroschisis when taken in the first trimester?

A) diphenhydramine (Benadryl)
B) chlorpheniramine (Chlor-Trimeton)
C) pseudophedrine (Sudafed)
D) Ibuprofen (Motrin, Advil)

A

C) pseudophedrine (Sudafed)

510
Q

Identify the true statement regarding PLLR labeling of drugs.

A) The new labeling system includes both male and female reproductive potential.
B) All drugs will use the new system by 2019.
C) The new system rates drug safety on a scale of 1 to 10.

A

A) The new labeling system includes both male and female reproductive potential.

511
Q

What is the teratogenic or fetotoxic effect on the newborn whose mother was treated with tetracycline during pregnancy?

A) Advanced genital development of males
B) Abnormalities of teeth discoloration
C) Hyperbilirubinemia
D) Ototoxicity

A

B) Abnormalities of teeth discoloration

512
Q

Based on physiological changes in the kidney during pregnancy, which adjustment would the advanced practice nurse anticipate for a patient in her third trimester who has been taking a drug excreted only by the kidneys?

A) Decreased dosage to protect the fetus
B) Increased dosage because of accelerated clearance
C) Rescheduling of drug administration times
D) No changes would be expected

A

B) Increased dosage because of accelerated clearance

513
Q

The drug that will cross the placenta the most readily is:

A) Lipid soluble
B) Ionized
C) Higher polarity
D) Protein bound

A

A) Lipid soluble

514
Q

A 27 year old G1P0 comes to see you for her 1st prenatal visit at 6.3 weeks gestation. She indicates has been taking Accutane for her acne. The best course of action is to:

A) schedule her for an ultrasound as soon as possible
B) advise her to stop Accutane until after 12 weeks gestation
C) advise her to stop Accutane immediately and arrange a visit with the perinatologist as soon as possible
D) advise her that termination should be considered

A

C) advise her to stop Accutane immediately and arrange a visit with the perinatologist as soon as possible

515
Q

Of the antibiotics listed below which is considered safest for a pregnant client?

A) Levofloxacin (Levaquin)
B) Doxycycline (Vibramycin)
C) Erythromycin (Ery-TaB)
D) Ciprofloxin (Cipro)

A

C) Erythromycin (Ery-TaB)

516
Q

When prescribing medications for pregnant women, it is important for prescribers to be aware of the physiological changes during pregnancy as these impact drug absorption, metabolism, distribution, and excretion. One major physiologic change in pregnancy that impacts drug prescribing is:

A) Decreased gastric acid secretion
B) Increase in plasma volume
C) Decreased blood flow
D) Decreased transit time in the large intestine

A

B) Increase in plasma volume

517
Q

Which of the following medications should pregnant women avoid in the third trimester?

A) Tylenol
B) Milk of Magnesia
C) Monistat
D) Ibuprofen

A

D) Ibuprofen

518
Q

Hemolysis can occur when a person with which condition receives nitrofurantoin (Macrobid, Macrodantin)?

A) Glucose-6-Phosphate dehydrogenase (G6PD) deficiency
B) Sickle cell anemia
C) Beta Thalassemia
D) Alpha Thalassemia

A

A) Glucose-6-Phosphate dehydrogenase (G6PD) deficiency

519
Q

A potential maternal complication of beta-mimetic tocolytic agents (such as Terbutaline ® and Ritodrine ®) is

A) bradycardia.
B) hypoglycemia.
C) pulmonary edema.
D) respiratory depression.

A

C) pulmonary edema.

520
Q

A woman with a G4P3 history and her last delivery 11 months ago, presents at 27 weeks gestation with a hemoglobin of 8.9. Her MCV is 66, Ferritin and serum iron levels are also decreased and TIBC is elevated. The clinician prescribes iron supplementation and provides the client with education about how she can best optimize her Iron absorption.
Which of the following recommendations should be included?

A) Take iron supplement after breakfast and dinner.
B) Take iron with coffee, tea or milk.
C) Increase dietary sources of iron to maximize iron absorption.
D) Take iron with the noon meal only.

A

C) Increase dietary sources of iron to maximize iron absorption.

521
Q

A woman requests an ultrasound “to be sure everything is okay with the baby”. It is the midwife/WHNP’s responsibility to:

A) discuss how decisions about ultrasounds are made with the woman and provide informed consent
B) encourage the woman to deter an ultrasound to a later date since this will provide a more accurate estimate of the EDB
C) carefully weigh the pros and cons of offering an ultrasound to the woman then inform the woman of the decision whether of not to order an ultrasound
D) order an ultrasound at the request of the woman

A

A) discuss how decisions about ultrasounds are made with the woman and provide informed consent

522
Q

Which of the following statements about prenatal risk assessment is FALSE?

A) Prenatal risk assessment helps women to choose the most appropriate place to give birth.
B) Prenatal risk assessment allows women to choose a healthcare provider who can best meet her individual needs.
C) Prenatal risk assessment provides information to women about whether or not their baby will have a specific defect for which there is a screening test.
D) Prenatal risk assessment allows women to improve health-promoting behaviors to reduce their risk.

A

C) Prenatal risk assessment provides information to women about whether or not their baby will have a specific defect for which there is a screening test.

523
Q

A 33-year-old Caucasian G5P4004 at 10 weeks gestation reports fatigue. Her body mass index (BMI) is 30. The results of her labs done last week include

1 hour oral glucose tolerance test (OGTT) - 120 mg/dL (normal)
Hemoglobin 10.0 g/dL
Hematocrit 32.1%
Based on the data given, which of the following is the most pertinent subjective data?

A) history of marijuana use
B) pregnancy spacing
C) alcohol use
D) presence of sclera jaundice

A

B) pregnancy spacing

524
Q

A 25 year old G2P1001 at 10 weeks gestation has a history of mild persistent asthma controlled with a beta agonist (albuterol) inhaler and inhaled corticosteroid (pulmicort). She is worried about the potential effects of the medication on her pregnancy. The nurse-midwife explains

A) the risks of uncontrolled asthma are greater than the risks of the medications.
B) beta agonists are associated with adverse perinatal outcomes like fetal growth restriction (FGR)
C) inhaled corticosteroids increase the risk of major congenital malformations.

A

A) the risks of uncontrolled asthma are greater than the risks of the medications.

525
Q

A 23 year-old G1 P0 is admitted at 41 weeks for induction of labor secondary to oliogohydramnios. Which of the following is a complication commonly associated with oligohydramnios in labor?

A) Cord prolapse
B) Fetal heart rate (FHR) decelerations
C) Placenta abruption
D) Chorioamnionitis

A

B) Fetal heart rate (FHR) decelerations

526
Q

Observation of Chadwick’s sign during a speculum exam is a

A) probable sign of pregnancy
B) positive sign of pregnancy
C) presumptive sign of pregnancy
D) sign of cervical dysplasia

A

A) probable sign of pregnancy

527
Q

A 31-year-old G1P0 at 8 weeks gestation reports extreme fatigue, cold intolerance, dry skin and hair loss. Appropriate screening test(s) for these symptoms include

A) thyroid stimulating hormone (TSH) and total T4.
B) free T3 and free T4.
C) total T3 and total T4.
D) thyroid stimulating hormone (TSH).

A

D) thyroid stimulating hormone (TSH)

528
Q

A woman at 15 weeks gestation stepped on a rusty nail that punctured the skin. Her last tetanus injection was over 10 years ago. It is most appropriate to tell her that:

A) tetanus immunoglobulin should be given rather than a booster
B) it is safe to get a tetanus booster in pregnancy
C) she needs serum testing before any further tetanus vaccination
D) she will be referred to infectious disease for the next step

A

B) it is safe to get a tetanus booster in pregnancy

529
Q

The midwife determines that a woman’s baby is breech. The woman is 39 weeks pregnant, and her blood type is A negative. Which is an appropriate verbatim statement regarding external cephalic version?

A) “External version is a procedure in which the fetus is turned to a cephalic presentation by external and internal manipulation.”
B) “This is the ideal time to consider this procedure. The physician will typically do this procedure between 38 and 40 weeks.”
C) “Some of the risks associated with external cephalic version include preterm labor, uterine rupture, fetal distress, and placenta previa.”
D) “You will need to get RhoGAM after the procedure because your blood type is A negative.”

A

D) “You will need to get RhoGAM after the procedure because your blood type is A negative.”

530
Q

Polyhydramnios is

A) an amniotic fluid index (AFI) of 19 cm or more.
B) when the maximum deepest vertical pocket is 6 cm or more.
C) most often an idiopathic condition.
D) associated with fetal renal agenesis.

A

C) most often an idiopathic condition.

531
Q

A pregnant woman with a history of a cone biopsy of the cervix is at increased risk for:

A) anemia
B) placental infarctions
C) preterm labor
D) thrombophlebitis

A

C) preterm labor

532
Q

Which of the following symptoms is most likely to be associated with an acute, ruptured ectopic pregnancy?

A) An elevated temperature
B) Profuse vaginal bleeding
C) Severe uterine cramping
D) Shoulder pain

A

D) Shoulder pain

533
Q

What is the best advice for a woman with a pre-pregnancy BMI of 18.1 regarding weight gain in pregnancy?

A) Gain 25-35 pounds during pregnancy
B) Gain at least 30 pounds during pregnancy
C) Gain 28-40 pounds during pregnancy
D) Gain at least 30 pounds during pregnancy

A

C) Gain 28-40 pounds during pregnancy

534
Q

A 25 year-old G2P1001 at 8 weeks gestation gives a history of major depression disorder (MDD). She has been on Sertraline (Zoloft) for 12 months and is now symptom free. The nurse-midwife discusses treatment options for depression during pregnancy including

A) the need to discontinue her selective serotonin reuptake inhibitor (SSRI) because of its strong association with persistent pulmonary hypertension of the newborn with first trimester exposure.
B) she may be a candidate for discontinuing her antidepressant after slowly tapering the dosage.
C) cognitive behavioral therapy is not an effective psychotherapy in pregnancy.
D) the majority of newborns exposed to selective serotonin reuptake inhibitors (SSRI) have a persistent alteration in behavior including restlessness and irritability.

A

B) she may be a candidate for discontinuing her antidepressant after slowly tapering the dosage.

535
Q

Correct collection of a Group B streptococcus specimen from a pregnant woman includes:

A) inner labia, lower third of the vagina, perineum.
B) posterior fornix, mid-vagina, anorectum
C) vaginal introitus, lower third of the vagina, anorectum.
D) vaginal introitus, mid-vagina, perineum.

A

C) vaginal introitus, lower third of the vagina, anorectum.

536
Q

Which of the following is the best example of appropriately discussing the option of adoption with a woman who has an unintended pregnancy?

A) “What are your thoughts about planning an adoption?”
B) “Have you considered putting your child up for adoption?”
C) “What are your feelings about keeping your child versus giving him up for adoption?”
D) “Would you ever consider giving your child away to an adoptive family?”

A

A) “What are your thoughts about planning an adoption?”

537
Q

A 32-year-old G2P1001 at 35 weeks gestation presents for care. You know the following: She works 50 hours per week at a retail chain store and smokes ½ pack per day (she has cut down from 1 PPD). Her weight gain to date is 18 pounds and her pre-pregnant BMI was 27.9. Her weight gain is:

A) Too rapid
B) Normal
C) Excessive
D) Inadequate

A

B) Normal

538
Q

A 26-year-old Asian woman at 12 weeks gestation is diagnosed with alpha thalassemia. Review of her labs reveal
RBC 5.8 (high)
RDW% (Red Cell Distribution Width) 11.5% (normal)
Hemoglobin 11.0 g/dL
Hematocrit 33.0%
MCV (Mean Corpuscular volume) 73 fL (low)
MCH (Mean Corpuscular hemoglobin) 22 pg (low)
Ferritin 50 mg/dL (normal)
Reticulcyte count normal
The most appropriate management plan includes

A) increased folate supplementation.
B) iron supplementation.
C) prenatal vitamin supplementation.
D) vitamin B12 supplementation.

A

C) prenatal vitamin supplementation.

539
Q

Risk assessment for issues related to pregnancy:

A) has decreased the number of Cesarean births
B) has significantly improved perinatal outcomes
C) is a critical predictor of adverse outcomes
D) is best when completed preconceptually

A

D) is best when completed preconceptually

540
Q

Which diameter of the pelvis is the narrowest that the fetus must traverse?

A) Transverse diameter of the midplane
B) AP diameter of the outlet
C) Diagonal conjugate
D) Conjugata vera

A

A) Transverse diameter of the midplane

541
Q

A woman presents to clinic for her first prenatal visit 9 weeks gestation. Her BMI is 33.1. The CNM/WHNP knows that she has an increased risk for:

A) Preeclampsia and operative birth
B) Postpartum hemorrhage and polyhydramnios
C) Stillbirth and placenta previa
D) Gestational diabetes and thyroid dysfunction

A

A) Preeclampsia and operative birth

542
Q

Which is a contraindication for vaginal birth after cesarean section (VBAC)?

A) Grand multiparity
B) Postterm pregnancy
C) Preeclampsia
D) Classical (vertical) uterine incision

A

D) Classical (vertical) uterine incision

543
Q

To reduce preterm birth and low birthweight, the most effective approach from a population standpoint would be universal:

A) cessation of illegal drug use.
B) access to affordable contraception.
C) cessation of tobacco use.

A

C) cessation of tobacco use.

544
Q

A 22-year-old G3P1011 at 7 weeks gestation by LMP presents to clinic reporting an episode of spotting yesterday the size of a 50-cent piece. She reports occasional headache and fatigue. Her uterus is enlarged on pelvic exam. The MOST important data to gather at this visit is:

A) Presence of pain
B) Urinalysis and culture
C) Presence of Nabothian cyst
D) Prior history of pregnancy bleeding

A

A) Presence of pain

545
Q

During her first prenatal visit, a woman mentions that she has not been interested in sexual relations with her partner recently. Which of the following is the best response to this question?

A) “Refraining from sexual intercourse during the first trimester is actually a good thing because of the potential for miscarriage.”
B) “Your libido will likely increase after 14 weeks gestation.”
C) “Sexual libido is decreased throughout pregnancy due to hormonal influences.”
D) “Decreased interest in sex occurs early in pregnancy because sexual intercourse is a bad idea until we for sure know the position of the placenta.”

A

B) “Your libido will likely increase after 14 weeks gestation.”

546
Q

Your client is a gravida 6, para 5005 at 37 weeks gestation who comes to her routine prenatal visit complaining of a tender blood vessel on her right anterior thigh. The midwife notes that the superficial vein is distended, warm, red, and slightly tender to touch. The midwife should:

A) Send her for a compression ultrasound to rule out a deep vein thrombosis.
B) Prescribe low-dose aspirin
C) Treat with acetaminophen, elastic support, and rest
D) Reassure that this is a normal discomfort of late pregnancy

A

A) Send her for a compression ultrasound to rule out a deep vein thrombosis.

547
Q

Megaloblastic anemia in pregnancy is most often associated with

A) folic acid deficiency.
B) microcytic red blood cells (RBC)
C) Vitamin B12 deficiency.
D) lower risk of neural tube defects (NTDs).

A

A) folic acid deficiency.

548
Q

A 28 year old G3P1011 is now 32 weeks gestation. Her BMI is 28. Her 1 hour glucose was 120 mg/dL. Her fundal height measurement has been consistently within 2 centimeters of her gestational week. Today her fundal height measurement is 34 centimeters. She is very anxious and asks what does the increased measurement mean? The midwife responds

A) “An increase in fundal height measurement is most often caused by a large baby.”
B) “Although there are several factors that can influence your fundal height measurement, often the cause for an increase in fundal height measurement is related to your body build and the way you carry the pregnancy.”
C) “An increase in fundal height measurement is frequently caused by an excessive amount of amniotic fluid.”

A

B) “Although there are several factors that can influence your fundal height measurement, often the cause for an increase in fundal height measurement is related to your body build and the way you carry the pregnancy.”

549
Q

A 38 year-old G1P0 at 40 weeks gestation had an ultrasound which revealed an estimated fetal weight (EFW) of 4750 grams. Her interval history has been benign. She is requesting a cesarean section due to the size of the baby and possible shoulder dystocia. The provider’s best response is

A) “Based on the evidence, you are at greater risk for having a shoulder dystocia when the EFW is 4500 grams or greater. I am going to recommend a cesarean section.”
B) “I understand how you feel and I agree that you are at greater risk for shoulder dystocia. I will schedule you for an induction tomorrow.”
C) “Ultrasounds in the 3rd trimester can be off by 1-2 lbs. The evidence supports the consideration of a cesarean section when the baby’s estimated fetal weight (EFW) is greater then 5000 grams. At this point it is safest for you to go into labor on your own.”

A

C) “Ultrasounds in the 3rd trimester can be off by 1-2 lbs. The evidence supports the consideration of a cesarean section when the baby’s estimated fetal weight (EFW) is greater then 5000 grams. At this point it is safest for you to go into labor on your own.”

550
Q

A woman desires a vaginal birth after Cesarean (VBAC). She had a vaginal birth with her first child and a Cesarean birth with her second child. What is the next most appropriate step?

A) confirm that she had a low transverse uterine incision.
B) perform an abdominal exam to evaluate for incision location.
C) discuss the situation with the consultant physician.
D) obtain full informed consent.

A

A) confirm that she had a low transverse uterine incision.

551
Q

A 30-year-old G4 P3003 with a history of two vaginal deliveries followed by a Cesarean for failure to progress desires a trial of labor after Cesarean (TOLAC). She has a pre-pregnant BMI of 31 and has gained 25 pounds this pregnancy. The estimated fetal weight is 4000 grams. Which of the following factors most positively influences the likelihood that the woman will have a successful vaginal birth after Cesarean (VBAC)?

A) She has had prior successful vaginal deliveries.
B) She is less than 35 years old.
C) Her last Cesarean was for failure to progress, which is not likely to occur again.
D) She has had appropriate weight gain this pregnancy.

A

A) She has had prior successful vaginal deliveries.

552
Q

Of the following examples, which is the preferred way to discuss VBAC risk with a woman?

A) “Your risk of uterine rupture is 0.2%.”
B) “Your risk of rupturing your uterus is 37 times greater than a woman who hasn’t had a c-section before.”
C) “Choosing to VBAC leads to 1.9 more uterine ruptures for every 1000 cesarean births.”
D) “Your risk of having a uterine rupture is 2 in 1000, so out of 500 women attempting VBAC only 1 will have a uterine rupture.”

A

D) “Your risk of having a uterine rupture is 2 in 1000, so out of 500 women attempting VBAC only 1 will have a uterine rupture.”

553
Q

Rhogam should be administered in which of the following situations?

A) To an Rh negative woman at her 24 week gestation prenatal visit
B) To a pregnant woman with unknown blood type having first trimester bleeding
C) Prior to genetic chorionic villus sampling (CVS) for an Rh negative woman at 12 weeks gestation
D) Before cordocentesis in an Rh positive woman

A

C) Prior to genetic chorionic villus sampling (CVS) for an Rh negative woman at 12 weeks gestation

554
Q

Which of the following does NOT influence the assessment of uterine size during the first trimester?

A) maternal habitus
B) uterine position
C) bladder status
D) polyhydramnios

A

D) polyhydramnios

555
Q

A woman calls your office at 38 weeks gestation telling you she has not felt the baby move in about 6 hours. She feels well otherwise. The next appropriate step is to:

A) advise to eat something
B) ask if she has taken Naproxen recently
C) ask about her activity today
D) advise that you’ll meet her in the ER now

A

C) ask about her activity today

556
Q

A 30-year-old presents to clinic today for her first visit. Her history contains the following: Her LMP was 12 weeks ago and she recorded it on her calendar. Her uterus is palpable at the symphysis. Her BMI is 28 and her weight gain to date is 11 pounds. The best advice to give her regarding her weight gain is:

A) Reassure her that as long as her food choices are nutritional, weight gain will not be an overly important issue in her pregnancy
B) Advise that she should gain about ½ per week for the remainder of her pregnancy
C) Refer to a dietician and advise no weight gain until mid-second trimester
D) Advise that her weight gain at this point is within normal limits for her

A

B) Advise that she should gain about ½ per week for the remainder of her pregnancy

557
Q

A G1P0 at 28 weeks gestation has a blood group history of B, Rh negative with an initial negative indirect coombs. She would like to avoid receiving any blood products during her pregnancy. The midwife counsels her

A) “Rhogam is synthetically produced and is not considered a blood product.”
B) “The most likely time for you to be exposed to your baby’s red blood cells occurs with delivery of the placenta. This increases the risks of hemolytic disease of the newborn with successive pregnancies.”
C) “Your first pregnancy is safe from the risk of RH sensitization since there is no risk of Rh sensitization until after birth.”
D) “ If you become Rh sensitized during this pregnancy you can still receive Rhogam after delivery to reverse the sensitization.”

A

B) “The most likely time for you to be exposed to your baby’s red blood cells occurs with delivery of the placenta. This increases the risks of hemolytic disease of the newborn with successive pregnancies.”

558
Q

A 22-year-old G1P0 at 8 weeks gestation presents to clinic with a report of bright red spotting of 2 days duration. She had her first OB visit at your clinic 2 weeks ago. Even though this is an unplanned pregnancy, she is tearful that something may be wrong. Of the following, the most appropriate action would be to:

A) Reassure her that she is young and that her fertility is at its peak
B) Advise her that most early pregnancy losses are due to natural selection
C) Ask her about the presence of breast tenderness
D) Consult with the consultant physician for management options

A

C) Ask her about the presence of breast tenderness

559
Q

A woman at 36 weeks’ gestation arrives at the hospital after experiencing a gush of blood from the vagina. She is visiting from another state and her medical records are unavailable. She had intercourse in the past 24 hours. The priority evaluation is a/an

A) Amnisure to check for ruptured membranes.
B) digital vaginal exam to check for dilatation.
C) sterile speculum exam to visualize the cervix.

A

C) sterile speculum exam to visualize the cervix

560
Q

A 44 year old G4P3003 at 33 weeks gestation is at her routine prenatal visit. Her interval history has been benign up to the point. Today her exam reveals: fundal height 30 cm; BP 132/84, trace protein; total weight gain of 19 lbs. The midwife should:

A) obtain baseline laboratories for suspected preeclampsia
B) obtain a 24 hour urine to rule out preeclampsia.
C) have her come back for a return visit in one week
D) order an ultrasound for size less than dates

A

D) order an ultrasound for size less than dates

561
Q

When is a Rhogam injection indicated?

A) At 28 weeks gestation when a Rh negative, indirect coombs negative woman’s fetal Rh status is unknown.
B) Within 72 hours of implantation bleeding (6-12 days post conception) in a Rh negative woman.
C) Within 72 hours postpartum, when the woman is Rh negative, indirect coombs negative with a Rh negative newborn.

A

A) At 28 weeks gestation when a Rh negative, indirect coombs negative woman’s fetal Rh status is unknown.

562
Q

When assessing a woman’s pelvis, the distance between the ischial spines normally measures approximately

A) 7 cm
B) 10 cm
C) 14 cm
D) 16 cm

A

B) 10 cm

563
Q

Which of the following screening methods is recommended by the CDC to screen for GBS status?

A) Screen all pregnant women at 35 to 37 weeks gestation.
B) Screen only women who have had GBS in their prenatal urine culture.
C) Screen all women upon admission to Labor & Delivery with a rapid screen.
D) Screen only women who have had ruptured membranes for over 18 hours, who are less than 37 0/7 weeks gestation, or who have a temperature in labor.

A

A) Screen all pregnant women at 35 to 37 weeks gestation.

564
Q

Which patient education point must be included when discussing fetal movement counts?

A) chart how long it takes to feel five fetal movements.
B) count fetal movements several times each week.
C) report any decrease in fetal movement.
D) count fetal movements prior to a meal.

A

C) report any decrease in fetal movement.

565
Q

A 31-year-old G1P0 at 8 weeks gestation reports daily vomiting, 2+ ketones, and 4 lb weight loss in the last 2 weeks. In addition to a CBC, it would be most appropriate to obtain a serum

A) lipase.
B) human chorionic gonadotropin (HCG).
C) glucose.
D) BUN and electrolytes.

A

D) BUN and electrolytes.

566
Q

SATA: A woman with type O, Rh-D negative blood group and a negative indirect coombs antibody titer needs to be given Rho(D) immine globulin (RogGAM) intramuscular (IM) injection:

A) at 28 weeks gestation.
B) within 72 hours after birth.
C) after a first trimester miscarriage.
D) after an amniocentesis.
E) after an external cephalic version attempt.

A

A) at 28 weeks gestation.
B) within 72 hours after birth.
C) after a first trimester miscarriage.
D) after an amniocentesis.
E) after an external cephalic version attempt.

567
Q

During the new obstetrical patient intake on a 29 year-old G5P0130 woman, the nurse midwife decides to order a thyroid stimulating hormone (TSH) based on her history of

A) postdates term birth.
B) multiple miscarriages.
C) placenta previa.
D) maternal age.

A

B) multiple miscarriages.

568
Q

Which of the following is an accurate statement regarding sexuality in pregnancy?

A) Women often experience increased sexual desire in the second trimester
B) Masculine attitudes towards the pregnant body are uniformly positive
C) Most couples report similar levels of sexual desire before and during pregnancy
D) Female orgasm is more difficult to achieve in the first and third trimesters.

A

A) Women often experience increased sexual desire in the second trimester

569
Q

A woman tells her midwife/WHNP that she doesn’t want to get an ultrasound at the hospital radiology department because it’s too expensive. She’d prefer to go to the Fetal Foto in the mall and get one there. What is the best response?

A) ACOG recommends that women not go to non-medical facilities for ultrasounds due to the lack of quality control.
B) Be sure they have certified ultrasonographers there so that your ultrasound is accurate
C) Since the ultrasound is mostly to see the baby and be sure it’s moving and has a heartbeat, this is fine.
D) Boutique ultrasound establishments provide a similar level of care as the hospital, so it is cost effective to go there instead of the hospital.

A

A) ACOG recommends that women not go to non-medical facilities for ultrasounds due to the lack of quality control.

570
Q

Which is true regarding the classic anthropoid pelvis?

A) It makes vaginal birth impossible in nearly all situations.
B) The anterior portion is quite large.
C) It has a very short sacrum.
D) The shape makes a posterior position of the fetus likely.

A

D) The shape makes a posterior position of the fetus likely.

571
Q

An African American woman is G3P1101 and is at 28 weeks gestation. Her lab work reveals
RBC 2.81 (low)
Hemoglobin 9.5 g/dL
Hematocrit 29.5%
MCV 73 fL (low)
MCH 26 pg (low)
RDW 15.3% (high)
The nurse-midwife is suspicious of

A) iron deficiency anemia.
B) sickle cell trait.
C) megaloblastic anemia.
D) beta thalassemia.

A

A) iron deficiency anemia.

572
Q

A primipara at 32 weeks gestation reports an increased amount of vaginal discharge with an unusual odor and uterine cramping. Her last prenatal care visit was at 24 weeks. What is the midwife’s priority today?

A) Counsel about the importance of prenatal care.
B) Evaluate for preterm labor.
C) Review physiologic leukorrhea with the patient.
D) Order a 1-hour glucose tolerance test.

A

B) Evaluate for preterm labor.

573
Q

The cardinal sign of placenta previa is

A) coagulopathy.
B) abnormally adherent placenta.
C) painless bleeding.
D) abnormal fetal heart tones.

A

C) painless bleeding.

574
Q

When a woman is experiencing preterm labor, does bedrest decrease the risk of preterm birth?

A) Yes
B) No
C) Only if her cervix is dilated
D) Study results vary

A

B) No

575
Q

A fetal fibronection may not be accurate if the woman has

A) had a vaginal exam earlier in the day
B) intact membranes.
C) had sexual intercourse 36 hours ago.
D) a history of preterm birth.

A

A) had a vaginal exam earlier in the day

576
Q

The pregnant person should be counseled that risks for coming in contact with toxoplasmosis are all of the following EXCEPT:

A) changing the litter box
B) contact with young children who are infected
C) eating raw or under cooked meats
D) or gardening in affected soil

A

B) contact with young children who are infected

Varney p. 841.

577
Q

A primipara at 39 weeks gestation desires a water birth and minimal interventions. Her BPs today have been 146/92 at 10 AM with 2 + proteinuria and 142/96 at 3 PM with 2+ proteinuria. Her bishop score is 7. The midwife should:

A) discuss the implications of preeclampsia and the need to induce today to reduce potential risk to mother and fetus.
B) discuss induction of labor with the woman and reassure her that she will be able to have a water birth.
C) discuss the implications of gestational hypertension and the need for close surveillance.
D) plan for induction of labor in 48 - 72 hours to increase the likelihood of a higher bishop score.

A

A) discuss the implications of preeclampsia and the need to induce today to reduce potential risk to mother and fetus.

578
Q

What does the presence of a vertical abdominal scar in a multiparous woman indicate?

A) a prior Cesarean section
B) the need to obtain additional health history data
C) that she should have a Cesarean birth
D) a vertical uterine incision

A

B) the need to obtain additional health history data

579
Q

The optimal time to receive the Tdap vaccine in pregnancy is:

A) between 20 and 26 weeks
B) after the end of the first trimester
C) between 27 and 36 weeks gestation
D) in the second trimester

A

C) between 27 and 36 weeks gestation

580
Q

A laboring person’s BMI is 47 and attempts to assess fetal well-being utilizing doppler and EFM have not been successful. Upon review of the procedure to include the risks, benefits and alternate options, the birthing person consents to placement of a Fetal Scalp Electrode (FSE). With this procedure, which of the following steps would occur first?

A) With the examining hand, rotate the electrode counterclockwise.
B) Release the electrode wires from the locking device at the end of the drive tube.
C) Confirm fetal lie, presentation, and position.
D) Rotate the drive tube clockwise until mild resistance is felt.

A

C) Confirm fetal lie, presentation, and position.

581
Q

At 14 weeks gestation, the fundus is expected to be palpable:

A) at the umbilicus
B) at the symphysis pubis
C) 2 to 3 finger breadths above the symphysis pubis
D) 2 finger breadths below the umbilicus

A

C) 2 to 3 finger breadths above the symphysis pubis

582
Q

A 38 year old G3P1011 is at 38 weeks gestation. Her BMI is 18.8 and she has gained 24 lbs. She was diagnosed with mild preeclampsia last week. As you get her ready for her non-stress test (NST) today, she says she has a mild backache, and she starts to have some bleeding that is running down her leg. The most important action for the clinician to take first is:

A) obtain a CBC
B) palpate her abdomen
C) do a stat vaginal exam
D) take her blood pressure

A

B) palpate her abdomen

583
Q

A 10 week gestation, 25 year-old Hispanic G4P3003 presents for prenatal care. Her body mass index (BMI) is 30. She denies a previous history of gestational diabetes. Her last baby weighed 9 lbs. (4,082 gm). According to ACOG, which risk factors would make her a candidate for early gestational diabetes screening?

A) Multiparity
B) Low socioeconomical status
C) Body mass index (BMI) > 30
D) Dietary recall consisting of large amounts of sugar

A

C) Body mass index (BMI) > 30

584
Q

At 16 weeks gestation a woman’s 1-hour, 50-g oral glucose challenge test result is 148 mg/dL. What is the next best step for her management?

A) Repeat the 1-hour, 50-g oral glucose tolerance test.
B) Instruct her to modify her diet and begin blood sugar testing.
C) Test her HbA1C level.
D) Order a 3-hour 100-g glucose tolerance test.

A

D) Order a 3-hour 100-g glucose tolerance test.

585
Q

Primary prevention is possible for which of the following conditions?

A) Trisomy 13
B) Cystic Fibrosis
C) Down Syndrome
D) Neural Tube Defects

A

D) Neural Tube Defects

586
Q

A woman arrives to clinic for her first prenatal visit. She wrote down the date of her last menstrual period, which was 11 weeks ago. She says she has regular, 31 day cycles with bleeding lasting 5 days. The best way to determine her EDB is to:

A) add on 3 days to the EDB determined by Naegele’s rule
B) obtain serum quantitative hCG today and again in 2 days
C) subtract 3 days from the EDB determined by Naegele’s rule
D) obtain a vaginal ultrasound within 1 to 2 weeks

A

A) add on 3 days to the EDB determined by Naegele’s rule

587
Q

Which of the following is the best ultrasound criterion for dating pregnancy?

A) a first trimester bi-parietal diameter measurement
B) a first trimester crown-rump length
C) an 18 week composite measurement of femur length, biparietal diameter, abdominal circumference, and head circumference
D) a 14 week femur length measurement

A

B) a first trimester crown-rump length

588
Q

The pelvic planes of obstetric significance are the:

A) midplane, diagonal conjugate, and outlet.
B) inlet, midplane, and outlet
C) inlet, posterior outlet, and anterior outlet.
D) linea terminalis, posterior outlet, and anterior outlet.

A

B) inlet, midplane, and outlet

589
Q

While questioning a woman about her last menstrual period (LMP) for the purposes of dating pregnancy, it is most important to ask the woman which of the following?

A) if she has ever missed a period before
B) if her LMP was normal
C) if she had intercourse during her LMP
D) if she had breast tenderness during her LMP

A

B) if her LMP was normal

590
Q

In a term pregnancy, oligohydramnios is defined as:

A) Amniotic fluid index (AFI) of less than 5
B) Single vertical fluid pocket of less than 3 cm
C) Amniotic fluid index (AFI) of less than 7
D) Not present if there is a reactive non-stress test (NST)

A

A) Amniotic fluid index (AFI) of less than 5

591
Q

Which is accurate regarding genital herpes and pregnancy?

A) Vertical transmission occurs in 30% of women with secondary herpes outbreaks.
B) Prophylaxis to prevent recurrent outbreaks is best taken from 38 weeks to term.
C) A primary herpes outbreak near the time of birth carries the greatest risk of neonatal infection.
D) Prophylactic therapy prevents all neonatal transmission during birth.

A

C) A primary herpes outbreak near the time of birth carries the greatest risk of neonatal infection.

Varney p. 481 “The greatest risk of intrapartum transmission to the infant is during a primary outbreak. Vaginal birth during a primary outbreak can have vertical transmission rates as high as 50%.”